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The experience of Albanese et al 1 is very interesting because it is a good example of the old adage that logical treatment works. The technique as taught by Scott does involve the injection of pretarsal botulinum toxin because it is spasm of the pretarsal muscle that causes the symptoms.
Injection of the preseptal muscle should not be expected to be as effective for controlling the symptom of lid spasm. Injection of the superciliaris is sometimes required to control the brow spasm that many of these patients get.
A similar study to that of Albanese et al 1has been reported locally with a similar result—the logical treatment of the pretarsal muscle is more effective (but produces slightly more side effects) than the less logical injection of the preseptal orbicularis.
I agree with the propositions of Kowel. In my experience, patients sometimes question the need for pretarsal botulinum toxin injections due to local pain at the time of treatment. Other side effects (for example, small local haematomas) are a minor concern.
I suspect that, after the pioneering treatments, injection sites have been gradually moved to preseptal and even to orbital locations to avoid local pain. This must be taken into account considering that many patients still do well with preseptal botulinum toxin injections.
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