The Influence of Benign Essential Blepharospasm on Dry Eye Disease and Ocular Inflammation

Lu, Rong; Huang, Runsheng; Li, Kang; Zhang, Xinchun; Yang, Hui; Quan, Yadan; Li, Qian

doi:10.1016/j.ajo.2013.11.014

Cited by 45 publications

(29 citation statements)

References 19 publications

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“…[ 5 – 8 ] Furthermore, several studies have indicated that DE symptoms in PBS patients could be improved by botulinum toxin injections. [ 9 – 11 ] These evidences made many researchers to concern about the interactional mechanism between PBS and DE. The study from Lu et al [ 11 ] showed several key inflammation cytokines of tear fluid increased more significantly in the patients with a diagnosis of both PBS and DE than in those with DE alone and meanwhile the DE symptoms of PBS + DE patients were more severe, thus the authors suggested that blepharospasm might participate in the progress of inflammation of the ocular surface in PBS + DE patients.…”

Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of meibomian glands in primary blepharospasm

Lin

Gong

2016

Medicine

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The aim of the study was to evaluate the morphological changes of meibomian glands (MGs) in primary blepharospasm (PBS) by in vivo laser scanning confocal microscopy (LSCM) and to investigate the correlations between clinical data of PBS and LSCM parameters of MGs. This prospective and case–control study recruited 30 consecutive PBS patients and 30 age- and gender-matched healthy controls. After questionnaire assessments of ocular surface disease index (OSDI), Jankovic rating scale, and blepharospasm disability index, all subjects underwent blink rate evaluation, tear film break-up time (TBUT), corneal fluorescein staining (CFS), Schirmer test, MG expressibility, meibum quality, MG dropout, and LSCM examination of the MGs. The main LSCM outcomes included the mean MG acinar area and density, orifice diameter, meibum secretion reflectivity, acinar irregularity, and inhomogeneity of interstice and acinar wall. The PBS patients had significantly higher blink rate, higher OSDI and CFS scores, lower TBUT and Schirmer test value, and worse MG expressibility than the controls (All P 0.05), whereas meibum quality showed no difference (P > 0.05). The PBS patients showed lower values of MG acinar area, orifice diameter and meibum secretion reflectivity, and higher scores of acinar irregularity and inhomogeneity of interstices than the controls (All P < 0.05). For the PBS patients, the severity of blepharospasm evaluated by JCR scale was strong correlated with MG acinar area (P < 0.001), orifice diameter (P = 0.002), meibum secretion reflectivity (P = 0.002), and MG acinar irregularity (P = 0.013). The MG expressibility was significantly correlated to MG acinar area (P = 0.039), orifice diameter (P < 0.001), and MG acinar irregularity (P = 0.014). The OSDI score was moderate correlated with MG acinar irregularity (P = 0.016), whereas the TBUT value was positively correlated with MG acinar area (P = 0.045) and negatively correlated to MG acinar irregularity (P = 0.016). The CFS score was negatively correlated to MG orifice diameter (P = 0.008). The LSCM provided a noninvasive tool for in vivo histopathologic studies of MGs in PBS patients. The excessive constriction of lid muscles closely related to MG morphological alterations of PBS, which offered a new research approach to interpret the interactional mechanism between dry eye and PBS.

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Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of meibomian glands in primary blepharospasm

Lin

Gong

2016

Medicine

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“…One study [10] followed up 324 cases of new-onset patients with dry eyes; 28 (57%) of the treatment-unresponsive patients were diagnosed with Meige syndrome. Rong's [11] studies reported that blepharospasm increased dry eyes and other eye inflammation, but focal botulinum toxin injection could relieve these symptoms. Thirty-two of the patients had photophobia, a condition in which bright light from various sources induced irritating ocular discomfort and increased spasms and made it more difficult for the patients to open their eyes; wearing tinted glasses or a hat has a positive effect on these symptoms.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Patients with Primary Blepharospasm: A Report of 100 Cases in China

et al. 2015

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Purpose: This study explored the clinical characteristics, diagnosis and treatments of primary blepharospasm. Methods: In this retrospective analysis, 100 patients with blepharospasm were enrolled. Data were collected from medical records and face-to-face interviews with patients and their families. Results: The age of onset was 56.4 ± 2.7 (range, 32-76 years). The duration between onset and accurate diagnosis was 38.7 ± 36.0 months (range, 2-120 months). Dry eyes occurred in 54% of the patients. The initial diagnostic accuracy was 10%. Dry eye syndrome, conjunctivitis/keratitis and myasthenia gravis caused the most confusion in the differential diagnosis. Regular botulinum toxin type A injections improved both eyelid spasms and subjective ocular symptoms in all patients. Conclusions: Regular botulinum toxin type A injections improved both eyelid spasms and subjective ocular symptoms in blepharospasm patients. The differentiation of primary blepharospasm differentiation from dry eye syndrome, conjunctivitis/keratitis and myasthenia gravis must be improved.

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“…However, whether the medial lower eyelid (MLE) should be involved in the treatment of patients with BEB remains unclear. Our previous study, which used a MLE-involved injection pattern, showed alleviation of dry eye symptoms via BoNT-A injection [ 14 ], while a study elsewhere, which used an injection pattern that avoided MLE, showed ineffectiveness of BoNT-A injection in treating dry eye symptoms [ 15 ]. Yet, since the injection sites of these two studies were quite different, it was impossible to make comparison and determine the effect of the MLE injection site on lacrimal drainage.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Botulinum Neurotoxin A Injection Patterns with or without the Medial Lower Eyelid in the Treatment of Blepharospasm

Yang

Lü

Zhao

et al. 2016

Journal of Ophthalmology

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The aim of this study was to evaluate the efficacy of two botulinum toxin A (BoNT-A) injection patterns with or without the medial lower eyelid (MLE) in treating benign essential blepharospasm (BEB) and influencing lacrimal drainage. Two different injection patterns of BoNT-A were randomly applied to 98 eyes of 49 BEB patients: MLE Group received a full injection pattern of 5 sites and non-MLE Group received a MLE waived injection pattern of 4 sites. Tear breakup time (BUT), Schirmer I test, lagophthalmos height, and lower lid tear meniscus height (TMH) were measured and Jankovic Rating Scale (JRS) was surveyed before injection and at 1 week, 1 month, and 3 months after injection. The symptom of BEB was relieved in both groups as suggested by JRS scores at all time points after injection, and MLE Group came up with a better JRS score at 3 months. The increases of Schirmer I test value and TMH in MLE Group were higher than those in non-MLE Group at 1 week after injection. This study shows that the MLE-involved full injection pattern is a better choice for patients with BEB. It has longer-lasting effects in relieving BEB symptoms and better efficacy in reducing lacrimal drainage. Clinical Trials registration number is NCT02327728.

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The Influence of Benign Essential Blepharospasm on Dry Eye Disease and Ocular Inflammation

Cited by 45 publications

References 19 publications

In vivo confocal microscopy of meibomian glands in primary blepharospasm

In vivo confocal microscopy of meibomian glands in primary blepharospasm

Clinical Analysis of Patients with Primary Blepharospasm: A Report of 100 Cases in China

Comparison of Two Botulinum Neurotoxin A Injection Patterns with or without the Medial Lower Eyelid in the Treatment of Blepharospasm

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