TY - JOUR
T1 - Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine
T2 - Case series of four patients
AU - Venkateswaran, Nandini
AU - Hwang, Jodi
AU - Rong, Andrew J.
AU - Levitt, Alexandra E.
AU - Diel, Ryan J.
AU - Levitt, Roy C.
AU - Sarantopoulos, Konstantinos D.
AU - Lee, Wendy W.
AU - Galor, Anat
N1 - Funding Information:
Supported by the Department of Veterans Affairs , Veterans Health Administration , Office of Research and Development , Clinical Sciences Research I01 CX002015 (Dr. Galor), Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (Dr. Galor), Department of Defense GW190010 (Dr. Galor), R01EY026174 (Dr. Galor), NIH Center Core Grant P30EY014801 and Research to Prevent Blindness Unrestricted Grant. Funding sources had no involvement in study design; in the collection, analysis or interpretation of data; in the writing of this report; or in the decision to submit the article for publication.
Publisher Copyright:
© 2020
PY - 2020/9
Y1 - 2020/9
N2 - Purpose: Individuals receiving botulinum toxin A (BoNT-A) injections in the head and neck for migraine treatment have reported decreases in photophobia and sensations of dryness, independent of ocular surface parameters. We hypothesized that patients without migraine but with similar ocular neuropathic-like symptoms would also experience symptomatic improvement with periocular BoNT-A injections, independent of ocular surface changes. Observations: We identified four individuals without a history of migraine but with neuropathic ocular pain (symptoms of dryness, burning, and photophobia that were out of proportion to ocular surface findings and unresponsive to ongoing dry eye (DE) therapies). Individuals underwent 1 session of periocular BoNT-A injections. Validated questionnaires (Visual Light Sensitivity Questionnaire-8, Dry Eye Questionnaire-5) assessed photophobia and DE symptoms pre- and 1-month post-injections. All four reported improvements in frequency and severity of photophobia and eye discomfort following BoNT-A injections. Tear film parameters (phenol red thread test, tear break-up time, corneal staining, and Schirmer test) and eyelid (palpebral fissure height and levator palpebrae superioris function) and eyebrow (position) anatomy were also evaluated before and after injections. Despite a unanimous improvement in symptoms, there were no consistent changes in ocular surface parameters with BoNT-A injections across individuals. Conclusions: Periocular BoNT-A shows promise in reducing photophobia and sensations of dryness in individuals with neuropathic-like DE symptoms without a history of migraine, independent of tear film, eyelid, or eyebrow parameters.
AB - Purpose: Individuals receiving botulinum toxin A (BoNT-A) injections in the head and neck for migraine treatment have reported decreases in photophobia and sensations of dryness, independent of ocular surface parameters. We hypothesized that patients without migraine but with similar ocular neuropathic-like symptoms would also experience symptomatic improvement with periocular BoNT-A injections, independent of ocular surface changes. Observations: We identified four individuals without a history of migraine but with neuropathic ocular pain (symptoms of dryness, burning, and photophobia that were out of proportion to ocular surface findings and unresponsive to ongoing dry eye (DE) therapies). Individuals underwent 1 session of periocular BoNT-A injections. Validated questionnaires (Visual Light Sensitivity Questionnaire-8, Dry Eye Questionnaire-5) assessed photophobia and DE symptoms pre- and 1-month post-injections. All four reported improvements in frequency and severity of photophobia and eye discomfort following BoNT-A injections. Tear film parameters (phenol red thread test, tear break-up time, corneal staining, and Schirmer test) and eyelid (palpebral fissure height and levator palpebrae superioris function) and eyebrow (position) anatomy were also evaluated before and after injections. Despite a unanimous improvement in symptoms, there were no consistent changes in ocular surface parameters with BoNT-A injections across individuals. Conclusions: Periocular BoNT-A shows promise in reducing photophobia and sensations of dryness in individuals with neuropathic-like DE symptoms without a history of migraine, independent of tear film, eyelid, or eyebrow parameters.
KW - Botulinum toxin A
KW - Dry eye syndrome
KW - Neuropathic ocular pain
KW - Neuropathic-like dry eye syndrome
KW - Photophobia
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U2 - 10.1016/j.ajoc.2020.100809
DO - 10.1016/j.ajoc.2020.100809
M3 - Article
AN - SCOPUS:85087697380
VL - 19
JO - American Journal of Ophthalmology Case Reports
JF - American Journal of Ophthalmology Case Reports
SN - 2451-9936
M1 - 100809
ER -