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Sang-Uk Choi, Kyoung-Woo Kim, Se Hoon Oh, Jae Chan Kim; Eyelid tension reduction for treating intractable dry eyes and quantification using an eyelid tensiometer. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4364. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
We evaluated eyelid tension using a novel eyelid tensiometer and quantified the effect of reduced eyelid tension by injecting botulinum toxin A to treat severe intractable dry eye (DE) combined with filamentary keratitis or superior limbic keratoconjunctivitis (SLK).
Forty eyes from 20 patients with intractable severe DE (level 3 or 4) and filamentary keratitis or SLK were included. Patients were subcutaneously injected with botulinum toxin A (2.5 units/0.1 mL per site) in each medial and lateral pretarsal orbicularis muscle of the upper eyelid. After verifying intra- and interobserver reliability, static and dynamic eyelid tension forces were measured using a newly developed eyelid tensiometer before and at one and three months after injection. At the same time, the Schirmer I test was performed, and tear film break-up time (tBUT) and corneal staining score (CSS) were estimated as clinical outcome measurements.
The intra- and interobserver reliability of the invented eyelid tensiometer were excellent, with intraclass correlation coefficients ranging from 0.988 to 0.991 and from 0.988 to 0.992, respectively. The mean patient age was 57.95 +- 3.37 years. Tear secretion, tBUT, and CSS, as well as corneal filaments and superior bulbar conjunctival erosions in SLK improved, and significant reduction in both static and dynamic lid tension was observed at one (1.026 +- 0.013 N and 1.162 +- 0.027 N, respectively) and three months (1.068 +- 0.011 N and 1.286 +- 0.044 N, respectively) compared to baseline before botulinum toxin A injection (1.102 +- 0.016 N and 1.456 +- 0.058 N, respectively).
The change in eyelid tension after botulinum toxin A injection to treat intractable severe DE combined with SLK or filamentary keratitis was quantitatively measured using the novel eyelid tensiometer. Eyelid tension reduction can be a clinically useful treatment for the management of intractable severe DE with elevated eyelid tension.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
A newly developed eyelid tensiometer consisting of (A) a speculum and a voltage meter. (B) The sensor and the magnet are labeled on each arm of the speculum. Counterweights are used to conversion formula convert millivolts to Newton.
The change in main outcomes at baseline and at one and three months after botulinum toxin A injection. **p < 0.01, vs. baseline. Repeated measures analysis of variance followed by Bonferroni post hoc were used.
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