Botox which was first developed in the 1980s by Dr. Allan Scott in San Francisco for use in blepharospasm and strabimus is widely used today for these same reasons, as well as cosmetic indications.  The Botulinum toxin paralyzes the neuromuscular junction and is very useful in patients who have blepharospasm or rapid blinking of the eyes.  It is also useful in other patients who have hemifacial spasm or other neurologic problems.   These injections cause the patient's overactive muscles to fire less rapidly and thus cause lessening of the patient's symptoms.  The injections last from three to six months and must be repeated.  They are not permanent.  Patients may become resistant to the injections and need to have the dose increased.  Botox is also used cosmetically to remove wrinkles in the periocular area.  This works quite well and is done in the office without the need for going to the operating room.  Patients with blepharospasm, hemifacial spasm, or deep rhytids in the face and forehead may wish to consider Botox as an alternative and should consult an oculpastic surgeon for evaluation of this problem.