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.
Highlights
Benign essential blepharospasm (BEB) is a condition of bilateral orbicularis oculi dystonia with unknown etiology, which leads to intermittent or complete involuntary eyelid closure and vision impairment [1]
For the non-medial lower eyelid (MLE) Group, none of the follow-up tear breakup time (BUT) were statistically different from the baseline; Schirmer I test value increased at Week 1 only (p = 0.034); the lower lid tear meniscus height (TMH) increased at Week 1 (p = 0.000) and Month 1 (p = 0.003)
When comparing the two groups, the improvement in tear BUT at all time points showed no significant difference between the two groups; the increase of Schirmer I test value of the MLE Group was higher than that of the non-MLE Group at Week 1 and Month 1; the increase of the lower lid TMH of the MLE Group was more than that of the non-MLE Group at Week 1
Summary
Benign essential blepharospasm (BEB) is a condition of bilateral orbicularis oculi dystonia with unknown etiology, which leads to intermittent or complete involuntary eyelid closure and vision impairment [1]. Common manifestations of BEB include dry eyes, photophobia, unpleasant sensations, eyelid fluttering, and increased frequency of blinking [2]. Botulinum neurotoxin A (BoNT-A) injection is a wellestablished treatment for blepharospasm and was firstly used to treat blepharospasm in 1985 [5]. BoNT-A injection can induce different side effects such as blurred vision, diplopia, lagophthalmos, eyelid ptosis, and increased lacrimation [7]. Rather than the preseptal portion of the orbicularis oculi, is more effective for treatment of BEB [8]. In patients with resistant blepharospasm, the pretarsal portion of the orbicularis oculi should be involved [9]. Used injection sites include the lateral upper and lower eyelid margins, the medial upper eyelid margin, and the lateral canthi, while additional sites differ greatly depending on patients’ symptoms and the ophthalmologists’ experience [8, 10,11,12,13]
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