Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients

Nandini Venkateswaran; Jodi Hwang; Andrew J. Rong; Alexandra E. Levitt; Ryan J. Diel; Roy C. Levitt; Konstantinos D. Sarantopoulos; Wendy W. Lee; Anat Galor

doi:10.1016/j.ajoc.2020.100809

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Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients

Journal article

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Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients

Nandini Venkateswaran, Jodi Hwang, Andrew J. Rong, Alexandra E. Levitt, Ryan J. Diel, Roy C. Levitt, Konstantinos D. Sarantopoulos, Wendy W. Lee and Anat Galor

American journal of ophthalmology case reports, Vol.19, p.100809

09/01/2020

DOI: 10.1016/j.ajoc.2020.100809

PMCID: PMC7350146

PMID: 32671286

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Abstract

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. 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. 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.

Botulinum toxin A

Dry eye syndrome

Neuropathic ocular pain

Neuropathic-like dry eye syndrome

Photophobia

Details

Title: Subtitle: Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients
Creators: Nandini Venkateswaran - University of Miami
Jodi Hwang - University of Miami
Andrew J. Rong - University of Miami
Alexandra E. Levitt - University of Miami
Ryan J. Diel - University of Iowa
Roy C. Levitt - United States Department of Veterans Affairs
Konstantinos D. Sarantopoulos - University of Miami
Wendy W. Lee - University of Miami
Anat Galor - University of Miami
Resource Type: Journal article
Publication Details: American journal of ophthalmology case reports, Vol.19, p.100809
Publisher: Elsevier Inc
DOI: 10.1016/j.ajoc.2020.100809
PMID: 32671286
PMCID: PMC7350146
ISSN: 2451-9936
eISSN: 2451-9936
Language: English
Date published: 09/01/2020
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9984697642002771

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