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Impressum
Changes in tear function and ocular surface parameters after botulinum toxin a treatment in blepharospasm and hemifacial spasm patients
Horwath-Winter J., Berglöff J., Flögel I., Haller-Schober E. M., Schmut O.
Universitäts-Augenklinik, Auenbruggerplatz 4, Graz, Österreich
Purpose: Botulinum toxin A has shown to be an effective treatment
for patients with essential blepharospasm and hemifacial spasm and may
relieve dry eye symptoms as well. In the present study, the effect of
botulinum toxin A injections on tear function parameters and on the morphology
of the ocular surface in patients suffering from blepharospasm was investigated.
Methods: Botulinum toxin A injections were applied to 12 patients
with blepharospasm and to 3 patients with hemifacial spasm. The majority
of the patients also complained of dry eye symptoms and were using artificial
tears. A subjective questionnaire and ocular examinations including break-up
time, Schirmer test without local anesthesia, and rose bengal staining
were evaluated before, 1 week, 1 month and 3 months after injection. Impression
cytology was performed before and 3 months after injection.
Results: Though every patient got relief from blepharospasm after
botulinum toxin A treatment, only 3 patients noticed an improvement of
dry eye symptoms, 7 patients noticed no difference and 5 complained of
increasing symptoms. No significant difference in break-up time was observed
1 week, 1 month and 3 months after injection. Schirmer test measurements
after injection were found significantly reduced. Rose bengal staining
increased 1 week after injection. Impression cytology showed no definite
change in conjunctival cell morphology after botulinum toxin A injection.
Discussion: The pars lacrimalis of the orbicularis muscle is considered
to be responsible for the pumping action of lacrimal drainage. Botulinum
toxin A treatment leads to reduced lacrimal drainage that may improve
dry eye symptoms. In our patients, treatment with botulinum toxin A resulted
in an impaired tear function observed by reduced Schirmer test measurements.
The increase in rose bengal staining of the ocular surface could be the
result of the orbicularis muscle weakness leading to increased ocular
surface exposure because of poor blinking and lagophthalmus.