F. Khulamkhanova, M. Kataev, A. Kim
Moscow Helmholtz Eye Research Institute, Ocular Trauma Department
Moscow, Russian Federation


Eyelids reconstruction after traumatic injuries frequently needs step-by-step approach. In cases wherea madarosis occurs, the ciliary margin reconstruction is performed lastly. However, not so much a cosmetic result but an eyelashes protective functionand an eyelid support structure reconstructionare the primary treatment aims. To achieve better results and eyelashes engraftment, the immobilization (tharsorraphy) for a period from 4 to 6 month is necessary because of the high muscular activity of adnexa. This may demand one more stage - blepharotomy, which may cause supplementary cicatrical deformity of eyelid’s margins. A 4-6 months long tarsorraphy may also cause a patient’s mental discomfort.

To evaluate the efficiency of the eyelids immobilization using Botulinum toxin A during the eyelashes transplantation in cases of traumatic madarosis. 

Materials and methods

A 53 y.o. male with traumatic upper eyelid coloboma10x3 mm in the mid 1/3. In 7 days before the eyelashes graft transplantation, a Botulinum toxin A injection by 15units inthe musculus levator area and 10 units in the preseptal and pretharsal portions of orbicularis (up to 2 units in each point) was performed. By the time of surgery the full upper eyelid ptosisand orbicularis palsy were achieved. Eyelashes graft transplantation without tarsorraphy was performed.


Postoperative results were evaluated in 4 months after the surgery, when full eyelid’s mobility was achieved. We observed no complications of the engraftment, only minimal scaring.


Using Botulinum toxin A for upper eyelid immobilizationbefore eyelashes graft transplantation allows to achieve good functional and cosmetic results, avoid additional surgery and preserve patient’s mental comfort during rehabilitation period.