 After local or general anaesthesia has been applied, the botulinum toxin is injected directly into the selected eye muscles using a specially designed needle electrode that is connected to an electromyography (EMG) apparatus as well as to a syringe containing the botulinum toxin solution.When under local anaesthesia, the patient is asked to move the eyes just before the toxin is injected.This results in an EMG signal which provides instant feedback on the correct placement of the needle.