Purchase this article with an account.
Joonhyung Yeo, Jae Chan Kim; Effects of botulinum toxin type A for the treatment of dry eye syndrome and tear biomarkers. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5173.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Injection of botulinum toxin type A (BTX-A) in the medial part of the eyelid was previously reported to decrease the amount of tear volume ejected at each blink and the ability to drain tears, favoring the maintenance of the teardrop which may benefit patients with dry eye. This study tested the hypothesis that BTX-A injection can not only improve dry eye signs and symptoms, but also reduce a level of tear matrix metalloproteinase (MMP)-9 and serotonin.
In this retrospective study, 13 patients who treated with BTX-A for intractable severe dry eye (level 3 or 4) and 13 age-matched controls were included. In BTX-A group, patients were injected with BTX-A (2.5units/0.1mL per site) in each medial pretarsal orbicularis muscle of the upper and lower eyelid. In a control, only eye drops were administered. Before and at two weeks, one, two, four months after injection, dry eye symptoms (Ocular Surface Disease Index, OSDI), signs (tear film break-up time, TBUT; Schirmer I test; corneal fluorescein staining score, CFS) were assessed. A level of tear MMP-9 and serotonin was measured before and at one month after injection.
Twenty-six patients were included with a mean age of 57.8 years, and 80.8% (n=21) of patients were female. At baseline, no statistically significant differences were detected between BTX-A and control groups. Up to two months after injection, the eyes in BTX-A group showed lower OSDI scores compared with control group(25.5±14.9, 48.2±13.3, respectively; p=0.019). TBUT was found to be increased up to two months after injections in BTX-A group (p=0.006). The CFS were significantly lower in BTX-A group at one and two months (1.1±0.6; p=0.005, 1.0±0.6; p=0.001), and the Schirmer I test showed better measurement in the same group at two weeks and one month (6.9±1.0; p=0.03, 7.5±1.5; p=0.004). In addition, BTX-A reduced a level of tear MMP-9 and serotonin significantly one month after injection (p<0.001). There were no complications during the observations.
Our results are consistent with our hypothesis that BTX-A injection in the medial part of the lower and upper eyelid is an effective procedure that improves signs and symptoms of patients with dry eye and reduces a level of tear cytokines. However, the effect of BTX-A injection lasted only about two months. Further studies with a larger population will be needed to clarify the effect of BTX-A on dry eye syndrome.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only