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Nandini Venkateswaran, Jodi Hwang, Andrew Rong, Alexandra Levitt, Roy Levitt, Wendy Lee, Anat Galor; Onabotulinum toxin A improves photophobia and sensations of dryness independent of ocular surface parameters. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6757.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effects of one periocular onabotulinum toxin A (BoNT-A) treatment in patients with neuropathic photophobia and dry eye symptoms not related to migraine.
Retrospective evaluation of 6 individuals prior to and one month after a single BoNT-A treatment (total 35 units in the following injection sites: 5 units in procerus, 10 units in corrugators, 20 units in frontalis) at the Bascom Palmer Eye Institute between March 2018 and November 2018. Patient demographic information was reviewed. Validated questionnaires (Visual Light Sensitivity Questionnaire-8 and Dry Eye Questionnaire-5) assessed photophobia and dry eye symptoms before and after treatment. Brow position and eyelid anatomy (palpebral fissure height, levator function) and tear film parameters (phenol red test, tear breakup time, corneal staining, and Schirmer’s tear test) were also measured before and after treatment.
BoNT-A was administered to 6 patients (50% female, mean age 52) who reported symptoms of dryness, burning, and photophobia that were out of proportion to their ocular surface findings and also unresponsive to previous dry eye therapies, without a history of migraine. Overall, photophobia and dry eye symptoms improved one month after BoNT-A treatment. There was a mean improvement in photophobia frequency of 1.00, p=0.04, as measured by the VLSQ-8 questionnaire (range 0 to 5). Similarly, there was a mean improvement in the frequency of eye discomfort of 1.2, p=0.05 and intensity of eye discomfort of 1.3, p=0.04, as measured by the DEQ-5 questionnaire (range 0 to 5). These improvements were independent of brow position, eyelid anatomy and tear film parameters, which did not change before and after treatment.
In patients with neuropathic dry eye symptoms not related to migraine, photophobia and sensations of dryness improved after a single BoNT-A treatment, independent of ocular surface, brow position and eyelid anatomy parameters. Further studies are needed to evaluate the efficacy of this treatment modality.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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