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.
Highlights
Clinical usage of botulinum neurotoxin (BoNT) in ophthalmology can trace back to the 1970s, which was first introduced by Dr Alan Scott as an alternative for strabismus treatment [1]
In this model, decreased aqueous tear production was observed with corneal fluorescein staining following the injection of 1.25 milliunits of BoNT-B into the lacrimal gland for one month
These authors found that 1.25 or 2.5 U of BoNT caused a significant reduction in aqueous tear production after one week
Summary
Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan Received: 31 December 2018; Accepted: 22 January 2019; Published: 24 January 2019
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