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Galindo-Ferreiro A, Fraile García M, Schellini S, Sanchez-Tocino H. Objective assessment of tear film in blepharospasm, facial hemispam and aberrant regeneration with periocular botulinum toxin-A. Eur J Ophthalmol 2024:11206721241266008. [PMID: 39056135 DOI: 10.1177/11206721241266008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
PURPOSE Study the effect on the tear film in blepharospasm (BEB), facial hemispasm (FH), or aberrant regeneration (AR) treated with Botulinum Toxin (BTX-A). METHODS A prospective study was used to evaluate the tear film in patients with BEB, FH, or AR treated with BTX-A. Schirmer tests, break-up time (BUT), optical coherence tomography (OCT) meniscus measurement, the Ocular Surface Disease Index (OSDI) questionnaire, and Oxford scale were documented before; 1 month after; and 3 months after BTX-A treatment. Comparisons were made with the Friedman test and Wilcoxon matched-pairs signed rank test was used. A p-value <0.05 was considered statistically significant. RESULTS A total of 35 eyes from 27 patients were included. The mean patient age was 66.81 ± 12.94 years and 18 (66.7%) were female. Ten (37%) patients had BEB, six (22.2%) had FH, and 11 (40.74%) had AR. BTX-A improved the lid spasms. One month after BTX-A, Schirmer tests showed slight increments (Schirmer 1 p = 0.009; Schirmer 2 p = 0.05) and at 3 months they became similar to pre-treatment (p = 0.5). The BUT test was not significantly different at 1 month (p = 0.450) or at 3 months. On OCT 1 month after BTX-A, there was an increase in tear meniscus area (p = 0.004), height (p = 0.007), and depth (p = 0.004), and at 3 months the measurements also became similar to the pre-BTX-A values. No significant changes in the OSDI (p = 0.717) and Oxford scale (p = 0.255). CONCLUSION OCT is a good tool to detect the increase in tear meniscus after periocular BTX-A in BEB, FH, and AR.
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Affiliation(s)
| | - Marta Fraile García
- Department of Ophthalmology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Silvana Schellini
- Department of Ophthalmology, Medical School, State University of Sao Paulo (UNESP), Botucatu, São Paulo, Brazil
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Yabumoto C, Osaki MH, Osaki T, Gameiro GR, Campos M, Osaki TH. Ocular Surface Metrics in Blepharospasm Patients After Treatment With Botulinum Toxin Injections. Ophthalmic Plast Reconstr Surg 2023; 39:475-478. [PMID: 36928309 DOI: 10.1097/iop.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this study was to assess blepharospasm patients regarding the effect of botulinum toxin in ocular surface parameters. METHODS A prospective study was performed in blepharospasm patients treated with onabotulinumtoxinA. A smartphone (iPhone 6S, Apple) and custom-made software were used to record the eyelid movements for 3 minutes in a standardized manner. Optical coherence tomography of the tear meniscus was used to assess the tear meniscus area. Tear break-up time and the Ocular Surface Disease Index questionnaire were also evaluated. Patients were assessed before and 15 days after botulinum toxin injections. RESULTS Forty eyes of 20 patients were evaluated. The frequency of the spontaneous eyelid movements was significantly reduced after treatment (23.18 ± 12.85 movements/min vs. 9.29 ± 6.87 movements/min; p < 0.0001). Significant increases in the tear meniscus area (0.020 ± 0.015 mm 2 vs. 0.057 ± 0.104 mm 2 ; p = 0.01) and in break-up time (4.2 ± 1.2 seconds vs. 5.1 ± 1.3 seconds; p = 0.03) were observed 15 days after treatment. A significant reduction in the Ocular Surface Disease Index (59.05 ± 19.04 vs. 21.2 ± 19.5; p < 0.0001) was also observed. CONCLUSION Significant changes in the tear meniscus area, break-up time, and Ocular Surface Disease Index after treatment reflect the effect of botulinum toxin on the lacrimal pump and in the improvement of dry eye symptoms. Reduction of eyelid spasms after treatment in blepharospasm patients was demonstrated using a smartphone and custom-made software. Thus, beyond relieving eyelid spasms, botulinum toxin injections were associated with subjective and objective improvement of dry eye parameters in patients with blepharospasm.
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Affiliation(s)
- Cristina Yabumoto
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine - EPM, Federal University of S. Paulo - UNIFESP, S. Paulo, SP, Brazil
| | - Midori H Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine - EPM, Federal University of S. Paulo - UNIFESP, S. Paulo, SP, Brazil
- Eye & Eyelid Experts, São Paulo, SP, Brazil
| | - Teissy Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine - EPM, Federal University of S. Paulo - UNIFESP, S. Paulo, SP, Brazil
- Eye & Eyelid Experts, São Paulo, SP, Brazil
| | - Gustavo R Gameiro
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine - EPM, Federal University of S. Paulo - UNIFESP, S. Paulo, SP, Brazil
| | - Mauro Campos
- Divisions of Cornea and Refractive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine - EPM, Federal University of S. Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Tammy H Osaki
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine - EPM, Federal University of S. Paulo - UNIFESP, S. Paulo, SP, Brazil
- Eye & Eyelid Experts, São Paulo, SP, Brazil
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Rayess YA, Awaida CJ, Jabbour SF, Ballan AS, Sleilati FH, Abou Zeid SM, Nasr MW. Botulinum toxin for benign essential blepharospasm: A systematic review and an algorithmic approach. Rev Neurol (Paris) 2020; 177:107-114. [PMID: 32654779 DOI: 10.1016/j.neurol.2020.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Currently, there is no standardised approach for benign essential blepharospasm treatment with botulinum toxin, and controversies still exist regarding this subject. OBJECTIVE The objective of this systematic review is to summarise and compare all the published data regarding benign essential blepharospasm treatment with botulinum toxin. METHODS On October 3, 2018, an online search of the Medline database was conducted. All articles with a detailed description of their botulinum toxin injection technique for benign essential blepharospasm were included in this review. RESULTS Five studies were selected for inclusion with a total of 854 patients. Four of the included studies used onabotulinumtoxin A and one study used abobotulinumtoxin A. All studies injected the pretarsal orbicularis occuli muscle. The preseptal orbicularis occuli was injected in four studies, and the preorbital muscle in three studies. The most commonly used method of evaluation was the Jankovic Rating Scale. Adverse events were transient, and dose related. Ptosis was more frequently encountered with the preseptal orbicularis injections. CONCLUSION Botulinum toxin injection for benign essential blepharospasm is a non-invasive and safe procedure. The pretarsal muscle should be considered as the key component when treating benign essential blepharospasm with botulinum toxin. We developed an algorithmic approach to the treatment of benign essential blepharospasm with botulinum toxin. However, further randomised controlled trials are warranted.
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Affiliation(s)
- Y A Rayess
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Paris Saint-Joseph Hospital, Paris, France.
| | - C J Awaida
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - S F Jabbour
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - A S Ballan
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - F H Sleilati
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - S M Abou Zeid
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - M W Nasr
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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Ho RW, Fang PC, Chang CH, Liu YP, Kuo MT. A Review of Periocular Botulinum Neurotoxin on the Tear Film Homeostasis and the Ocular Surface Change. Toxins (Basel) 2019; 11:toxins11020066. [PMID: 30678375 PMCID: PMC6409927 DOI: 10.3390/toxins11020066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 02/05/2023] Open
Abstract
Clinical usage of botulinum neurotoxin (BoNT) in ophthalmology has dramatically increased since the 1980s and has become one of the most widely used agents for treating facial movement disorders, autonomic dysfunction and aesthetic wrinkles. Despite its high efficacy, there are some complications with periocular BoNT injections due to its chemodenervation effect. Among these, there is still controversy over the BoNT effect on tear film homeostasis and the ocular surface. A periocular BoNT injection could dry the eye by reducing tear production of the lacrimal gland and increase tear evaporation due to potential eyelid malposition and abnormal blinks. On the contrary, the injection of BoNT in the medial eyelids could treat dry eye disease by impairing lacrimal drainage. Regarding the ocular surface change, corneal astigmatism and high-order aberrations may decrease due to less eyelid tension. In conclusion, the entire awareness of the effect of BoNT and the patients’ ocular condition is crucial for successful and safe results.
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Affiliation(s)
- Ren-Wen Ho
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 33302, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 33302, Taiwan.
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan.
| | - Yu-Peng Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 33302, Taiwan.
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Diaz AL, Chaparro TA, Tello A, Coy H, Frederick GA, Parra MM. Application of botulinum toxin in Horner's muscle for the treatment of dry eye. ACTA ACUST UNITED AC 2018; 93:617-620. [PMID: 30001848 DOI: 10.1016/j.oftal.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/METHODS The aim of this study is to describe the use of botulinum toxin to increase tear retention in patients with dry eye, using the description of 2 cases. RESULTS Patients with moderate to severe dry eye that were given an injection of type A botulinum toxin in the Horner's muscle. The results at one month and 3 months are reported. An assessment was made of the subjective perception of the patient as regards any improvement, as well as taking into account, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus. A significant improvement was observed in the subjective perception of the patient, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus at one month after treatment, and the good results still being maintained at the third month. There were no adverse events. DISCUSSION The use of type A botulinum toxin can be considered as an alternative to increase tear retention in moderate to severe dry eye, with a good response during the first month, with an acceptable response still being maintained at the third month. Given the temporary effect of the drug, further treatments would be required.
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Affiliation(s)
- A L Diaz
- Departamento de Cirugía Plástica Ocular, Fundación Oftalmológica de Santander, Floridablanca, Santander, Colombia
| | - T A Chaparro
- Departamento de Cirugía Plástica Ocular, Fundación Oftalmológica de Santander, Floridablanca, Santander, Colombia
| | - A Tello
- Departamento de Segmento Anterior, Fundación Oftalmológica de Santander, Floridablanca, Santander, Colombia
| | - H Coy
- Departamento de Cirugía Plástica Ocular, Fundación Oftalmológica de Santander, Floridablanca, Santander, Colombia
| | - G A Frederick
- Fundación Oftalmológica de Santander, Floridablanca, Santander, Colombia
| | - M M Parra
- Fundación Oftalmológica de Santander, Floridablanca, Santander, Colombia; Universidad Industrial de Santander UIS, Bucaramanga, Santander, Colombia.
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Increase lipid tear thickness after botulinum neurotoxin A injection in patients with blepharospasm and hemifacial spasm. Sci Rep 2018; 8:8367. [PMID: 29849166 PMCID: PMC5976660 DOI: 10.1038/s41598-018-26750-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/17/2018] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate changes in the tear film lipid layer thickness (LLT) and aqueous tear production after botulinum neurotoxin A (BoNT) injection in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS). Eleven and six patients with BEB and HFS, respectively, who received BoNT injection were consecutively enrolled in this prospective study. The blepharospasm disability index (BSDI), blink pattern, dry eye symptoms, Schirmer test 1 findings, LLT, eyelid performance, and corneal integrity were evaluated before and after treatment. Both BEB and HSF patients experienced remarkable relief from spasms and ocular discomfort after BoNT injection. LLT, the partial blink rate, the snap-back time, the lid distraction distance, and lateral canthal laxity were significantly increased at 1 month after treatment. There were no significant changes in Schirmer test 1 findings and meibomian gland dropout. Our findings suggest that LLT, a decisive factor for tear film stability, significantly increases at 1 month after BoNT injection for BEB and HFS. A decrease in BSDI and an increase in the snap-back time may contribute to the increase in LLT; this mechanism is probably responsible for the relief from dryness after BoNT injection in patients with facial movement disorders.
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