摘要

Objectives: To review efficacy and safety of Pyridostigmine as a treatment to refractory Botulinum-toxin related blepharoptosis Introduction: Pyridostigmine is viable therapeutic in the reversal of botulinum toxin-related blepharospasm that potentiates contraction of the levator palpebrae superioris. Its acts to inhibit destruction of acetylcholine, increasing its concentration at the presynaptic cleft, allowing the transmission of nerve implulses across the neuromuscular junction, effectively contracting the muscle. This is a presentation of two cases of botulinum toxin-induced blepharoptosis refractory to Brimonidine 0.2% ophthalmic solution that showed considerable improvement upon treatment with oral Pyridostigmine. Materials / method: Two healthy patients with unilateral blepharoptosis 5 days post post-botulinum toxin injection of the corrugator muscle were each given Pyridostigmine 60 mg/tab, 1 tablet every 6 hours on full stomach for 1 week as a monotherapy. Results: Retraction of the upper eyelid at 2mm was initially reported by both patients following 8 doses (2 days of treatment of Pyridostigmine 60 mg. Sustained effect was noted with 6-hourly dosing. The first patient reported lid retraction of 3 mm on day 5 of treatment and the second patient on day 6. Full lid retraction was reported on the 15th and 16th day of treatment, respectively. Conclusion: Pyridostigmine, when used correctly, decreases recovery period of from post-botulinum toxin blepharoptosis (15-16 days) compared to no treatment (28-42 days) with tolerable side effects. Further studies are recommended to strengthen the hypothesis and to explore its viability as a monotherapy or part of a combination regimen.