Department of Ophthalmology and Visual Sciences (MHO, THO, TO, RB), Paulista School of Medicine/EPM, Federal University of São Paulo/UNIFESP, São Paulo, São Paulo, Brazil; University of São Paulo Medical School (GRG), University of São Paulo/USP, São Paulo, São Paulo, Brazil; and Laboratory of Molecular and Cellular Biology (SKNM), Department of Neurology, University of São Paulo/USP, São Paulo, São Paulo, Brazil.
J Neuroophthalmol. 2020 Jun;40(2):193-197. doi: 10.1097/WNO.0000000000000823.
Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty.
Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses.
When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied.
Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.
尽管在面肌痉挛（HFS）中，未受影响的一侧在临床上似乎正常，但尚不清楚从组织病理学发现来看，这一侧是否可以被认为是正常的。本研究的目的是客观评估和比较 HFS 患者（未接受过肉毒毒素治疗）和接受美容上眼睑成形术的对照患者的眼轮匝肌样本。
评估了 22 个眼睑的眼轮匝肌样本。HFS 患者的受累侧和未接受过肉毒毒素治疗的未受累侧各有 7 个样本，正常对照患者有 8 个样本。使用苏木精和伊红染色制备肌肉样本，并使用数字图像分析软件进行客观分析。
与正常对照组相比，HFS 受累侧的肌内膜和肌周膜结缔组织面积显著增加（P = 0.015），提示这种紊乱与导致肌肉变性的慢性改变有关。与正常对照组相比，HFS 受累侧（P = 0.028）和未受累侧（P = 0.003）的细胞密度显著降低。尽管如此，在研究的 HFS 患者中，未受累侧的临床均没有出现肌肉收缩增加的迹象或症状。
在 HFS 患者的眼轮匝肌中观察到双侧均存在明显的形态学差异。我们的研究结果表明，HFS 患者双侧的肌肉内稳态紊乱可能起作用。然而，HFS 患者的受累侧确实存在肌肉变性，而未受累侧则没有。
