Journal francais d'ophtalmologie · 2026
Effects of botulinum toxin on tear film and corneal epithelial remodeling in patients with essential blepharospasm.
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Kesimal B, Kocamış S I, Doğan A Ş
Аннотация
PURPOSE: Benign essential blepharospasm (BEB) is a focal dystonia characterized by involuntary eyelid contractions that can disrupt tear film stability and corneal morphology. Botulinum toxin type A (BTX-A) injection is the standard treatment, yet its impact on ocular surface health and corneal epithelial structure remains unclear. This study aimed to assess the effects of periocular BTX-A on tear film parameters and corneal epithelial remodeling using anterior segment optical coherence tomography (AS-OCT).
METHODS: This retrospective, single-center study included 35 eyes of 35 BEB patients treated with standardized periocular BTX-A injection (total dose ∼12.5 units). Ocular surface parameters Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), Schirmer test, tear meniscus height (TMH), and meibomian gland dropout were evaluated at baseline and 3 months post-treatment. Corneal epithelial maps obtained via AS-OCT provided central, superior, and inferior epithelial thicknesses and irregularity indices. Corneal power and astigmatism were analyzed by topography. Pre- and post-treatment values were compared using paired tests.
RESULTS: At 3 months, blepharospasm severity and OSDI scores improved significantly (P<0.001). TBUT and TMH increased (P<0.001), while Schirmer test and gland dropout were unchanged. Superior epithelial thickness increased and irregularity indices decreased (P<0.001), indicating smoother remodeling. Corneal power and astigmatism decreased significantly (P<0.001), consistent with corneal flattening. No adverse effects were observed. Improvements correlated with reduced spasm severity.
CONCLUSION: BTX-A injection in BEB patients alleviates spasms and enhances tear film stability and epithelial regularity. The treatment is safe and well tolerated, offering additional ocular surface benefits beyond motor symptom control.
METHODS: This retrospective, single-center study included 35 eyes of 35 BEB patients treated with standardized periocular BTX-A injection (total dose ∼12.5 units). Ocular surface parameters Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), Schirmer test, tear meniscus height (TMH), and meibomian gland dropout were evaluated at baseline and 3 months post-treatment. Corneal epithelial maps obtained via AS-OCT provided central, superior, and inferior epithelial thicknesses and irregularity indices. Corneal power and astigmatism were analyzed by topography. Pre- and post-treatment values were compared using paired tests.
RESULTS: At 3 months, blepharospasm severity and OSDI scores improved significantly (P<0.001). TBUT and TMH increased (P<0.001), while Schirmer test and gland dropout were unchanged. Superior epithelial thickness increased and irregularity indices decreased (P<0.001), indicating smoother remodeling. Corneal power and astigmatism decreased significantly (P<0.001), consistent with corneal flattening. No adverse effects were observed. Improvements correlated with reduced spasm severity.
CONCLUSION: BTX-A injection in BEB patients alleviates spasms and enhances tear film stability and epithelial regularity. The treatment is safe and well tolerated, offering additional ocular surface benefits beyond motor symptom control.