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Tear meniscus, corneal topographic and aberrometric changes after botulinum toxin-a injection in patients with blepharospasm and hemifacial spasm

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Abstract

Purpose

To investigate the effect of botulinum neurotoxin-A (BTX-A) treatment on dry eye symptoms, tear meniscus, corneal topography and corneal aberrometry in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS).

Materials and methods

This prospective study comprised of 6 patients with BEB and 20 patients with HFS. Tear meniscus height (TMH) and depth (TMD), tear break-up time (TBUT), corneal fluorescein staining score (CFSS), Schirmer I test, ocular surface disease index (OSDI) score, corneal topography [corneal power of flat axis (K1), corneal power of steep axis (K2), mean corneal power (Km), astigmatism and thinnest pachymetry] and anterior corneal aberrometry [spherical aberration (SA), vertical coma (vcoma), horizontal coma (hcoma), higher order root mean square (hRMS) and total RMS] were evaluated before BTX-A treatment, 3 weeks after BTX-A treatment and 2 months after BTX-A treatment.

Results

Six patients with BEB and 20 patients with HFS treated with BTX-A were evaluated in this study. Twenty contralateral spasm free eyes of 20 HFS patients were taken as control group. TMH and TMD were found to be significantly higher in eyes with spasm at both 3 weeks and 2 months after injection (TMH: 279.0 ± 123.2 at pretreatment, 380.5 ± 174.7 at third week and 317.0 ± 125.5 at second month p < 0.001 and p = 0.02, respectively), (TMD: 183.7 ± 59.7 at pretreatment, 235.7 ± 91.1 at third week and 209.8 ± 77.1 at second month p < 0.01 and p = 0.015, respectively). TBUT, CFSS, Schirmer I test values were similar (p > 0.05). OSDI scores decreased significantly from 29.6 ± 25.3 to 19.8 ± 20. p = 0.03 at third week and increased again by second month. K2 (43.9 ± 1.7 vs. 43.7 ± 1.6, p = 0.03) and astigmatism (0.8 ± 0.5 vs. 0.6 ± 0.4, p = 0.04) values were significantly lower at third week and increased again by second month. Pachymetry and aberrometric values did not change significantly. In the control group only Schirmer I test value decreased significantly at second month (10.5 ± 6.5 vs. 7.2 ± 5.6, p = 0.008), other parameters did not change.

Conclusion

BTX-A injection increases tear meniscus and decrease symptoms related to dry eye disease in BEB and HFS patients. It decrease astigmatism and keratometry values, it does not cause a significant change in corneal aberrations. However the positive effects of BTX-A injection on ocular surface is temporary.

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Authors and Affiliations

  1. Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey

    Neslihan Bayraktar Bilen & Özlem Evren Kemer

  2. Department of Neurology, Ankara Bilkent City Hospital, Ankara, Turkey

    Şule Bilen

  3. Private Practice, Ankara, Turkey

    Pınar Topçu Yılmaz

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  1. Neslihan Bayraktar Bilen
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  2. Şule Bilen
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Contributions

Dr. Bayraktar Bilen—Data collection, manuscript submission and coordination, statistical analysis; Dr. Bilen—Coordination and data collection; Dr. Topçu Yılmaz—Data and Manuscript Editing; and Evren Kemer—Consultants to the procedure.

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Correspondence to Neslihan Bayraktar Bilen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ankara Numune Education and Research Hospital E-19-2606) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Informed consent for potential research publication was obtained from all individual participants included in the study at the time of their treatments performed.

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Bayraktar Bilen, N., Bilen, Ş., Topçu Yılmaz, P. et al. Tear meniscus, corneal topographic and aberrometric changes after botulinum toxin-a injection in patients with blepharospasm and hemifacial spasm. Int Ophthalmol 42, 2625–2632 (2022). https://doi.org/10.1007/s10792-022-02253-1

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