Increase lipid tear thickness after botulinum neurotoxin A injection in patients with blepharospasm and hemifacial spasm

Ren-Wen Ho, Po-Chiung Fang, Tsai-Ling Chao, Chun-Chih Chien, Ming-Tse Kuo, Ren-Wen Ho, Po-Chiung Fang, Tsai-Ling Chao, Chun-Chih Chien, Ming-Tse Kuo

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.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The injection sites scheme for the treatment of benign essential blepharospasm (BEB, left part) and hemifacial spasm (HFS, right part). The dose was 2.5 units per point. For BEB, 12-13 periocular points, 6 on each side with/without 1 procerus muscle, are injected. For HFS, 6-7 periocular points and 2-3 facial points on affected site are injected. ‘x’ means fixed injection point and ‘o’ means elective injection point.
Figure 2
Figure 2
The performance indices with statistically significant changes after injection of botulinum neurotoxin. (A–E) show the differences of the performance indices before and after injection of botulinum neurotoxin by means of boxplots. (F–J) show the changes of the performance indices after injection of botulinum neurotoxin by means of scatter plots. BoNT, botulinum neurotoxin (A) BSDI, blepharospasm disability index; Partial blink, the ratio of incomplete blinks divided by total blinks during the same 20-s assessment.
Figure 3
Figure 3
The associations between change of lipid layer thickness and changes of the potential indices of eyelid performance after injection of botulinum neurotoxin. (A) the correlation between change of partial blink change of lipid layer thickness. (B) the correlation between change of blepharospasm disability index and change of lipid layer thickness. (C) the correlation between change of snap-back test and change of lipid layer thickness. (D) the correlation between change of distraction test and change of lipid layer thickness. LLT, lipid layer thickness; BSDI, blepharospasm disability index; BoNT, botulinum neurotoxin A.

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