Injection sites and dosing in the orbicularis oculi

There are 3 approved injection sites for BOTOX® in the treatment of Blepharospasm.1

Note: These are general areas, not the specific injection sites.

Blepharospasm dosing information

  • The initial recommended dose is 1.25 Units to 2.5 Units (0.05 mL to 0.1 mL volume at each site). The recommended dilution to achieve 1.25 Units is 100 Units/8 mL; for 2.5 Units it is 100 Units/4 mL1
  • The cumulative dose of BOTOX® treatment for Blepharospasm in a 30-day period should not exceed 200 Units1
  • Reconstituted BOTOX® is injected using a sterile, 27- to 30-gauge needle without electromyographic guidance1
  • Avoiding injection near the levator palpebrae superioris may reduce the complication of ptosis1
  • Avoiding medial lower lid injections may reduce the complication of diplopia. Ecchymosis can be prevented by applying pressure at the injection site immediately after injection1
  • Initial effect of the injections is generally seen within 3 days and reaches a peak 1 to 2 weeks post-treatment. Each treatment lasts approximately 3 months, following which the procedure can be repeated1
  • At repeat treatment sessions, the dose may be increased up to twofold if the response from the initial treatment is considered insufficient, usually defined as an effect that does not last longer than 2 months. However, there appears to be little benefit obtainable from injecting more than 5 Units per site. Some tolerance may be found when BOTOX® is used in treating Blepharospasm if treatments are given any more frequently than every 3 months, and it is rare to have the effect be permanent1

Reconstitution and dilution guidelines

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