Ocular Surface Alterations in Essential Blepharospasm Patients Treated with Botulinum Toxin A Injection

Abstract

Objective: To explore the inf luence of ocular surface stability secondary to botulinum toxin A injection in patients with essential blepharospasm by comparing the changes in ocular surface indexes. Methods: In this prospective study, 30 patients with essential blepharospasm were recruited and underwent botulinum toxin A injections at the Affiliated Hospital of Yan'an University (January to June 2017). Ocular examinations, including frequency and severity of blepharospasm (using JRS chat), ocular surface symptoms (using OSDI questionnaire), tear break-up time and corneal fluorescence staining with slit-lamp examination, and tear secretion by a Schirmer Ⅰtest, were performed before and 2 weeks after botulinum toxin A injections. Results were analyzed with a paired t-test and spearman correlation test. Results: Of the 30 patients (60 eyes) with essential blepharospasm who were enrolled in this study, 60%(18/30) showed dry eye symptoms, and the OSDI scores were positively correlated with JRS scores (r=0.278, P=0.032). Botulinum neurotoxin A treatment relieved blepharospasm in all the patients and JRS scores decreased from 5.5±1.0 to 0.6±1.0 (t=25.730, P<0.001). At the same time, dry eye symptoms also improved in 12 patients (12/18), and OSDI scores decreased from 34.0±7.8 to 21.7±9.1 (t=7.946, P<0.001). BUT increased from 6.3±2.1 s to 8.0±2.0 s (t=4.389, P<0.001), and corneal fluorescence staining scores decreased from 1.0±1.0 to 0.6±0.7 (t=2.963, P=0.004). All the differences were statistically significant. Conclusions: Botulinum toxin A injection is effective for dry eye symptoms secondary to essential blepharospasm. Key words: blep harospasm; botulinum toxin A; xerophthalmia