Skip to main content

Advertisement

SpringerLink
Log in

Characteristics of tear abnormalities associated with benign essential blepharospasm and amelioration by means of botulinum toxin type A treatment

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the characteristics of tear abnormalities with benign essential blepharospasm (BEB) and the effect of botulinum toxin type A (BTX-A) treatment.

Study Design

Prospective and clinical study.

Methods

Forty eyes of 40 patients (12 men and 28 women, ages 63.5 ±12.9) with BEB and tear abnormalities were enrolled.

Results

The average scores for subjective symptoms as evaluated by the visual analog scale (VAS) were 46.3 and Dry Eye-Related Quality-of-Life Score (DEQS) were 63.7. The fluorescein breakup time (FBUT) was 2.7 ± 1.6 sec. Among fluorescein breakup patterns (FBUPs), dimple break, with the corresponding mechanism of decreased wettability was the most frequent, observed in 29 eyes (73%). The NEI score was 0.4 ± 0.7 and the van Bijesterveld score was 0.6 ± 0.8; the Schirmer 1 test value was 13.1 ± 9.4 mm. Eighteen patients received BTX-A treatment, and significant improvement was found in severity of subjective symptoms both on VAS and DEQS as well as for FBUT. The main FBUPs changed from dimple break to random break.

Conclusion

Tear abnormalities seen in BEB correspond to short BUT-type dry eye (DE), subclassified into decreased wettability DE in view of FBUPs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lu R, Huang R, Li K, Zhang X, Yang H, Quan Y, et al. The influence of benign essential blepharospasm on dry eye disease and ocular inflammation. Am J Ophthalmol. 2014;157:591–7.

    Article  Google Scholar 

  2. Grandas F, Elston J, Quinn N, Marsden CD. Blepharospasm: a review of 264 patients. J Neurol Neurosurg Psychiatry. 1988;51:767–72.

    Article  CAS  Google Scholar 

  3. Defazio G, Livrea P. Primary blepharospasm: diagnosis and management. Drugs. 2004;64:237–44.

    Article  Google Scholar 

  4. Anderson RL, Patel BC, Holds JB, Jordan DR. Blepharospasm: past, present, and future. Ophthal Plast Reconstr Surg. 1998;14:305–17.

    Article  CAS  Google Scholar 

  5. Tsubota K, Fujihara T, Kaido M, Mori A, Mimura M, Kato M. Dry eye and Meige’s syndrome. Br J Ophthalmol. 1997;81:439–42.

    Article  CAS  Google Scholar 

  6. Wakakura M, Inoue J. Application of new Japanese version of diagnostic criteria for dry eye to essential blepharospasm. Rinsho Ganka. 2008;62:857–60 (in Japanese).

    Google Scholar 

  7. Park DI, Shin HM, Lee SY, Lew H. Tear production and drainage after botulinum toxin A injection in patients with essential blepharospasm. Acta Ophthalmol. 2013;91:e108–12.

    Article  Google Scholar 

  8. Tsubota K, Yokoi N, Shimazaki J, Watanabe H, Dogru M, Yamada M, et al. New perspectives on dry eye definition and diagnosis: a consensus report by the Asia Dry Eye Society. Ocul Surf. 2017;15:65–76.

    Article  Google Scholar 

  9. Toda I, Fujishima H, Tsubota K. Ocular fatigue is the major symptom of dry eye. Acta Ophthalmol (Copenh). 1993;71:347–52.

    Article  CAS  Google Scholar 

  10. Koh S, Maeda N, Hori Y, Inoue T, Watanabe H, Hirohara Y, et al. Effects of suppression of blinking on quality of vision in borderline cases of evaporative dry eye. Cornea. 2008;27:275–8.

    Article  Google Scholar 

  11. Shimazaki-Den S, Iseda H, Dogru M, Shimazaki J. Effects of diquafosol sodium eye drops on tear film stability in short BUT type of dry eye. Cornea. 2013;32:1120–5.

    Article  Google Scholar 

  12. Koh S. Clinical utility of 3% diquafosol ophthalmic solution in the treatment of dry eyes. Clin Ophthalmol. (Auckl., NZ). 2015;9:865–72.

    Article  CAS  Google Scholar 

  13. Yokoi N, Georgiev GA. Tear film-oriented diagnosis and tear film-oriented therapy for dry eye based on tear film dynamics. Investig Ophthalmol Vis Sci. 2018;59:Des13–des22.

    Article  CAS  Google Scholar 

  14. Yokoi N, Georgiev GA. Tear-film-oriented diagnosis for dry eye. Jpn J Ophthalmol. 2019;63:127–36.

    Article  Google Scholar 

  15. Yokoi N, Georgiev GA, Kato H, Komuro A, Sonomura Y, Sotozono C, et al. Classification of fluorescein breakup patterns: a novel method of differential diagnosis for dry eye. Am J Ophthalmol. 2017;180:72–85.

    Article  Google Scholar 

  16. Yokoi N, Kato H, Kinoshita S. The increase of aqueous tear volume by diquafosol sodium in dry-eye patients with Sjogren’s syndrome: a pilot study. Eye (Lond, Engl). 2016;30:857–64.

    Article  CAS  Google Scholar 

  17. Sakane Y, Yamaguchi M, Yokoi N, Uchino M, Dogru M, Oishi T, et al. Development and validation of the Dry Eye-Related Quality-of-Life Score questionnaire. JAMA Ophthalmol. 2013;131:1331–8.

    Article  Google Scholar 

  18. Koh S, Watanabe H, Hosohata J, Hori Y, Hibino S, Nishida K, et al. Diagnosing dry eye using a blue-free barrier filter. Am J Ophthalmol. 2003;136:513–9.

    Article  Google Scholar 

  19. Lemp MA. Report of the National Eye Institute/Industry workshop on clinical trials in dry eyes. CLAO J. 1995;21:221–32.

    CAS  PubMed  Google Scholar 

  20. van Bijsterveld OP. Diagnostic tests in the Sicca syndrome. Arch Ophthalmol. (Chic Ill : 1960). 1969;82:10–4.

    Article  CAS  Google Scholar 

  21. Guideline of clinical practice for blepharospasm. Nippon Ganka Gakkai zasshi. 2011;115:617–28. (in Japanese).

  22. Jankovic J, Havins WE, Wilkins RB. Blinking and blepharospasm. Mechanism, diagnosis, and management. JAMA. 1982;248:3160–4.

    Article  CAS  Google Scholar 

  23. Yokoi N, Uchino M, Uchino Y, Dogru M, Kawashima M, Komuro A, et al. Importance of tear film instability in dry eye disease in office workers using visual display terminals: the Osaka study. Am J Ophthalmol. 2015;159:748–54.

    Article  Google Scholar 

  24. Shimazaki J, Tsubota K, Kinoshita S, Oohashi Y, Shimomura Y, Tagawa Y, et al. Definition and diagnosis of dry eye 2006. Atarashii Ganka. 2007;24:181–4 (in Japanese).

    Google Scholar 

  25. Yang J, Shao N, Song W, Wei Q, Ou R, Wu Y, et al. Nonmotor symptoms in primary adult-onset cervical dystonia and blepharospasm. Brain Behav. 2017;7:e00592. https://doi.org/10.1002/brb3.592.

    Article  PubMed  Google Scholar 

  26. Bedarf JR, Kebir S, Michelis JP, Wabbels B, Paus S. Depression in blepharospasm: a question of facial feedback? Neuropsychiatr Dis Treat. 2017;13:1861–5.

    Article  CAS  Google Scholar 

  27. Evinger C, Bao JB, Powers AS, Kassem IS, Schicatano EJ, Henriquez VM, et al. Dry eye, blinking, and blepharospasm. Mov Disord. 2002;17(Suppl 2):S75–8.

    Article  Google Scholar 

  28. Argueso P, Spurr-Michaud S, Russo CL, Tisdale A, Gipson IK. MUC16 mucin is expressed by the human ocular surface epithelia and carries the H185 carbohydrate epitope. Investig Ophthalmol Vis Sci. 2003;44:2487–95.

    Article  Google Scholar 

  29. Gipson IK, Spurr-Michaud S, Tisdale A, Menon BB. Comparison of the transmembrane mucins MUC1 and MUC16 in epithelial barrier function. PloS One. 2014;9:e100393. https://doi.org/10.1371/journal.pone.0100393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Guidelines for clinical practice for dry eye. Nippon Ganka Gakkai Zasshi. 2019;123:489–592 (in Japanese).

  31. Knop E, Korb DR, Blackie CA, Knop N. The lid margin is an underestimated structure for preservation of ocular surface health and development of dry eye disease. Dev Ophthalmol. 2010;45:108–22.

    Article  Google Scholar 

  32. Snir M, Weinberger D, Bourla D, Kristal-Shalit O, Dotan G, Axer-Siegel R. Quantitative changes in botulinum toxin a treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm. Am J Ophthalmol. 2003;136:99–105.

    Article  CAS  Google Scholar 

  33. Ababneh OH, Cetinkaya A, Kulwin DR. Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm. Clin Exp Ophthalmol. 2014;42:254–61.

    Article  Google Scholar 

  34. Gunes A, Demirci S, Koyuncuoglu HR, Tok L, Tok O. Corneal and tear film changes after botulinum toxin-A in blepharospasm or hemifacial spasm. Cornea. 2015;34:906–10.

    Article  Google Scholar 

  35. Kocabeyoglu S, Sekeroglu HT, Mocan MC, Muz E, Irkec M, Sanac AS. Ocular surface alterations in blepharospasm patients treated with botulinum toxin A injection. Eur J Ophthalmol. 2014;24:830–4.

    Article  Google Scholar 

  36. Sahlin S, Chen E, Kaugesaar T, Almqvist H, Kjellberg K, Lennerstrand G. Effect of eyelid botulinum toxin injection on lacrimal drainage. Am J Ophthalmol. 2000;129:481–6.

    Article  CAS  Google Scholar 

  37. Ho RW, Fang PC, Chao TL, Chien CC, Kuo MT. Increase lipid tear thickness after botulinum neurotoxin A injection in patients with blepharospasm and hemifacial spasm. Sci Rep. 2018;8:8367.

    Article  Google Scholar 

  38. Isshiki Y, Ishikawa H, Mimura O. Changes in ocular higher-order aberrations following botulinum toxin treatment in patients with blepharospasm : BTX improves dry eye in patients with BEB. Jpn J Ophthalmol. 2016;60:486–91.

    Article  CAS  Google Scholar 

Download references

Acknowledgement

We thank Dr. Robert Latta for editing the English of the manuscript.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Yuka Hosotani, Mana Okamoto, Hiroto Ishikawa, Osamu Mimura & Fumi Gomi

  2. Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan

    Norihiko Yokoi, Aoi Komuro & Hiroaki Kato

Authors
  1. Yuka Hosotani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norihiko Yokoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mana Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroto Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aoi Komuro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroaki Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Osamu Mimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fumi Gomi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuka Hosotani.

Ethics declarations

Conflicts of interest

Y. Hosotani, None; N. Yokoi, Lecture Fee (Santen, Otsuka), Consultant fee (Rhoto, Alcon); M. Okamoto, None; H. Ishikawa, None; A. Komuro, None; H. Kato, None; O. Mimura, Lecture fee (TEIJIN, Santen), Speaker fee (Senju, Novartis, KOWA Pharmaceutical, GlaxoSmithKline, Otsuka, Sumitomo Dainippon, Pfizer); F. Gomi, Grant (Pfizer, Alcon, Novartis, Otsuka), Lecture fee (Santen, Senju, GlaxoSmithKline), Speaker fee (Bayer).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Yuka Hosotani

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hosotani, Y., Yokoi, N., Okamoto, M. et al. Characteristics of tear abnormalities associated with benign essential blepharospasm and amelioration by means of botulinum toxin type A treatment. Jpn J Ophthalmol 64, 45–53 (2020). https://doi.org/10.1007/s10384-019-00705-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-019-00705-3

Keywords

Search

Navigation