Paralysis of the orbicularis muscle of the eye using botulinum toxin type A in the treatment for dry eye

• Published in: Acta ophthalmologica (Oxford, England) England), 2017-03, Vol.95 (2), p.e132-e137
• Main Authors: Serna‐Ojeda, Juan Carlos, Nava‐Castaneda, Angel
• Format: Article
• Language: English
• Subjects: Aged; Blinking - physiology; botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - adverse effects; dry eye; Dry Eye Syndromes - diagnosis; Dry Eye Syndromes - drug therapy; Eye Movements - drug effects; eyelid; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - adverse effects; Oculomotor Muscles - drug effects; Oculomotor Muscles - physiopathology; Ophthalmology; Ophthalmoplegia - chemically induced; Ophthalmoplegia - diagnosis; Ophthalmoplegia - physiopathology; orbicularis muscle; Prospective Studies
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.13140

Purpose To evaluate the efficacy of botulinum toxin type A injection to cause orbicularis eyelid muscle paralysis to improve dry eye signs and symptoms. Methods A prospective, randomized, comparative eye‐to‐eye and interventional study was performed. Patients with dry eye symptoms and positive fluorescein corneal staining were included. Randomly one eyelid received a subcutaneous injection of botulinum toxin in the medial orbicularis muscle portion of the lower eyelid, and the other eye received placebo. The subjective evaluation was achieved with a questionnaire assessing symptoms, quality of vision and ocular comfort level. The objective evaluation included the measurement of the tear film break‐up time (TBUT), Schirmer's test and corneal and conjunctival staining. Results Twenty patients were included with a mean age of 59.5 years. Two weeks after the botulinum toxin injection, all patients showed a decrease in the horizontal movement of the lower eyelid when blinking. The eyes in the active treatment group showed better scores compared with the sham group in four symptoms 4 weeks after the treatment. The TBUT was higher at 1 and 3 months in the active treatment group. The corneal and conjunctival staining were significantly lower in the active treatment group at 1 and 3 months, and the Schirmer's test showed better measurements in the same group at 2 weeks, 1 month and 3 months. There were no adverse events reported. Conclusions The injection of botulinum toxin A in the medial part of the lower eyelid is an effective and safe procedure that temporally improves some of the signs and symptoms of patients with dry eye.