Abstract
Background and Objectives: To evaluate the clinical efficacy of periocular botulinum toxin A (BTA) injection in patients with intractable dry eye disease (DED). Materials and Methods: Medical records of patients with intractable DED who underwent periocular BTA injection from December 2019 to March 2020 were reviewed retrospectively. Patients were injected with 2.5 units of BTA in the medial part of the lower eyelids. The clinical data collected included age, sex, ocular surface disease index (OSDI) score, tear film break up time (TBUT), Schirmer test results, tear osmolarity (I-PEN), and tear meniscus height (TMH) measured by anterior segment optical coherence tomography. All subjective and objective data were collected before treatment and at 1 month after treatment. Results: Twenty-eight consecutive patients were eligible for chart review and analysis. Significant improvements in OSDI, tear osmolarity, and TMH were observed at 1 month after periorbital BTA injection. At the baseline and 1-month follow-up examinations, OSDI scores were 62.22 ± 21.30 and 47.98 ± 17.23, respectively (p < 0.001). TMH increased significantly after treatment (82.25 ± 40.50 at baseline vs. 138.02 ± 66.62 1-month after treatment; p < 0.001). Tear osmolarity using I-PEN showed a significant decrease after treatment (320.82 ± 24.66 at baseline vs. 302.75 ± 22.33 at 1 month after treatment; p < 0.001). No significant differences were found in TBUT or Schirmer test results before and after BTA injection. Conclusions: BTA injection into the medial part of the eyelid improves dry eye symptoms, the amount of tear retention, and tear osmolarity. Based on the objective parameters of the tear condition, this study supports the idea of BTA use as a potential treatment option for patients with intractable DED.
Highlights
Dry eye disease (DED) has been defined recently as a “multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and is accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles, according to the International Dry Eye Workshop II [1]
Botulinum toxin A (BTA) is a neurotoxin that blocks the release of acetylcholine at the neuromuscular junctions of cholinergic nerves [3]
The objective tear film evaluation was based on the tear film break up time (TBUT), the Schirmer tear secretion test and I-PEN
Summary
Dry eye disease (DED) has been defined recently as a “multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and is accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles, according to the International Dry Eye Workshop II [1]. Numerous efforts have been made to overcome DED. Botulinum toxin A (BTA) is a neurotoxin that blocks the release of acetylcholine at the neuromuscular junctions of cholinergic nerves [3]. The blink reflex distributes tears over the ocular surface and is very important as it protects the eye against foreign objects contaminated with microbes [4]. In 1997, Spiera et al [5] first reported increased tear levels on the Schirmer test after treating essential blepharospasm with botulinum toxin in patients with Sjögren’s syndrome. In 2000, Sahlin et al [6] found
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