Comparison of Two Botulinum Neurotoxin A Injection Patterns with or without the Medial Lower Eyelid in the Treatment of Blepharospasm

Hui Yang, Jing Lu, Xiujuan Zhao, Xiaohu Ding, Zhonghao Wang, Xiaoyu Cai, Yan Luo, Lin Lu, Hui Yang, Jing Lu, Xiujuan Zhao, Xiaohu Ding, Zhonghao Wang, Xiaoyu Cai, Yan Luo, Lin Lu

Abstract

The aim of this study was to evaluate the efficacy of two botulinum toxin A (BoNT-A) injection patterns with or without the medial lower eyelid (MLE) in treating benign essential blepharospasm (BEB) and influencing lacrimal drainage. Two different injection patterns of BoNT-A were randomly applied to 98 eyes of 49 BEB patients: MLE Group received a full injection pattern of 5 sites and non-MLE Group received a MLE waived injection pattern of 4 sites. Tear breakup time (BUT), Schirmer I test, lagophthalmos height, and lower lid tear meniscus height (TMH) were measured and Jankovic Rating Scale (JRS) was surveyed before injection and at 1 week, 1 month, and 3 months after injection. The symptom of BEB was relieved in both groups as suggested by JRS scores at all time points after injection, and MLE Group came up with a better JRS score at 3 months. The increases of Schirmer I test value and TMH in MLE Group were higher than those in non-MLE Group at 1 week after injection. This study shows that the MLE-involved full injection pattern is a better choice for patients with BEB. It has longer-lasting effects in relieving BEB symptoms and better efficacy in reducing lacrimal drainage. Clinical Trials registration number is NCT02327728.

Figures

Figure 1
Figure 1
Injection sites in the MLE Group and the non-MLE Group for patients with BEB.
Figure 2
Figure 2
Changes in objective parameters of the MLE Group and the non-MLE Group before and after BoNT-A injection.
Figure 3
Figure 3
Changes in JRS score of the MLE Group and the non-MLE Group before and after BoNT-A injection.

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