Jariyakosol Supharat, Uthaithammarat Lita, Chatwichaikul Nattakarn, Kasetsuwan Ngamjit, Chongpison Yuda
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Ophthalmology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Clin Ophthalmol. 2021 Apr 28;15:1775-1782. doi: 10.2147/OPTH.S305817. eCollection 2021.
To assess the impact of botulinum toxin type A (BTX-A) on signs and symptoms of dry eye (DE) in affected eye of hemifacial spasm (HFS) patients and to compare the prevalence of DE between affected and non-affected eye in HFS patients.
This prospective study included participants with unilateral HFS, who received BTX-A injection as a treatment. The eyes ipsilateral to the spasm side were used as studied eyes and the contralateral eyes were used as controls. The Ocular Surface Disease Index (OSDI) score, tear break-up time (TBUT), corneal fluorescein staining, and Schirmer I test were measured at baseline, 1 and 3 months after BTX-A injection. Fluorescein clearance test (FCT) was evaluated at baseline and at 1 month after BTX-A injection.
Thirty-one participants (6 males and 25 females; mean age 61±10 years) were included. The prevalence of DE according to the Asia Dry Eye Society was not significantly different between affected (37.93%) and non-affected eyes (27.6%); P=0.083. At baseline, there was no significant difference in TBUT, Schirmer test, basal tear secretion, presence of delayed tear clearance, and presence of reflex tear secretion between affected and non-affected eyes, while significant difference in Oxford scheme grade was observed (P=0.031). OSDI score, TBUT, Oxford scheme grade, and Schirmer test at 1 month (P=0.817, 0.796, 0.534, 0.556), and 3 months (P=0.803, 0.904, 0.936, 0.684) after BTX-A injection did not significantly change from baseline in affected eyes. FCT results were not significantly different between baseline and at 1-month follow-up in both groups. All findings were corresponding in both naïve and long-term botulinum toxin injection groups.
We found no significant effect of BTX-A on signs and symptoms of DE in patients with HFS. Moreover, there was no significant association between HFS and DE. However, we found significant corneal surface damage in the affected eyes, which emphasized importance of ocular surface evaluation and prompt treatment in HFS patients.
评估A型肉毒毒素（BTX-A）对偏侧面肌痉挛（HFS）患者患眼干眼（DE）体征和症状的影响，并比较HFS患者患眼和未患眼的干眼患病率。
这项前瞻性研究纳入了接受BTX-A注射治疗的单侧HFS患者。将痉挛侧同侧的眼睛作为研究眼，对侧眼睛作为对照。在BTX-A注射前、注射后1个月和3个月测量眼表疾病指数（OSDI）评分、泪膜破裂时间（TBUT）、角膜荧光素染色和泪液分泌试验。在BTX-A注射前和注射后1个月评估荧光素清除试验（FCT）。
纳入31名参与者（6名男性和25名女性；平均年龄61±10岁）。根据亚洲干眼协会的标准，患眼（37.93%）和未患眼（27.6%）的干眼患病率无显著差异；P = 0.083。在基线时，患眼和未患眼在TBUT、泪液分泌试验、基础泪液分泌、泪液清除延迟和反射性泪液分泌方面无显著差异，但牛津分级有显著差异（P = 0.031）。BTX-A注射后1个月（P = 0.817、0.796、0.534、0.556）和3个月（P = 0.803、0.904、0.936、0.684）时，患眼的OSDI评分、TBUT、牛津分级和泪液分泌试验与基线相比无显著变化。两组在基线和1个月随访时的FCT结果无显著差异。在初次注射和长期注射肉毒毒素的组中，所有结果均一致。
我们发现BTX-A对HFS患者的干眼体征和症状无显著影响。此外，HFS与干眼之间无显著关联。然而，我们发现患眼存在显著的角膜表面损伤，这强调了HFS患者眼表评估和及时治疗的重要性。
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