J Korean Med Sci.  2006 Feb;21(1):131-135. 10.3346/jkms.2006.21.1.131.

The Changes in Corneal Astigmatism after Botulinum Toxin-A Injection in Patients with Blepharospasm

• Moon NJ
• Lee HI
• Kim JC

• KMID: 2157796
• DOI: http://doi.org/10.3346/jkms.2006.21.1.131

Abstract

To determine if the involuntary contractions of eyelids may have any effects on the development of corneal astigmatism, we performed this prospective study which includes 19 patients with either essential blepharospasm or hemifacial spasm. In hemifacial spasm, the degree of corneal astigmatism was evaluated between two eyes. Then the topographic changes were checked using vector analysis technique before and after passively opening the eyelids. They were also measured before and at 1 and 6 months after the injection of Botulinum toxin. Resultantly, 20 eyes had the with-the-rule (group1) and 9 eyes against-the-rule (group2) astigmatism. In hemifacial spasm, significantly more astigmatism was found at spastic eyes. The corneal topographic changes after passively opening the eyelids showed 10 eyes with the astigmatic shift to the with-the-rule, while the remaining 19 to the againstthe- rule. At 1 month after injection of Botulinum toxin, group 1 showed reduced average corneal astigmatism, whereas group 2 showed increased astigmatism. The astigmatic change vector showed significantly more against-the-rule. In the contrary, 6 months after treatment, corneal astigmatism again increased in group 1 and decreased in group 2. So they took on the appearance of pretreatment astigmatic status eventually. Conclusively eyelids may play an important role in corneal curvature.

Keyword

Astigmatism; Blepharospasm; Botulinum Toxin Type A; Corneal Topography; Eyelids

MeSH Terms

Aged
Astigmatism/*drug therapy/physiopathology
Blepharospasm/*drug therapy/physiopathology
Botulinum Toxin Type A/administration & dosage/*therapeutic use
Cornea/drug effects/physiopathology
Corneal Diseases/*drug therapy/physiopathology
Eyelids/drug effects/physiopathology
Female
Humans
Injections
Male
Middle Aged
Time Factors
Treatment Outcome

Figure

• 

  Fig. 1 Graphical method for calculating corneal astigmatism vector change. (A) If a corneal astigmatic measurement of a patient before botulinum toxin-A injection showed 1.75 diopter with its steepest axis 26 degree (right, marked as "Before") and changed to 1.5 diopter with 62 degree after treatment (left, marked as "After") then the resultant change vector is obtained by subtracting the preoperative value from the postoperative value (blue line). If the vector is drawn to the center (red line) then the apex reveals astigmatic change vector point (B). This case shows with-the-rule change (1 interval: 0.5 D).

• 

  Fig. 2 (A) The difference of astigmatism between two eyes of a patient having hemifacial spasm. Blue circle is representative for the amount and axis of astigmatism of healthy eye, while red circle for those of spastic eyes. Most of them have the against-the-rule astigmatism. The mean value is 0.85±0.24 D for the involved eyes and 0.58±0.18 D for the healthy eye. It was significantly different. (p<0.05 by t-test) (B) The corneal topographic changes after passively opening the eyelids in spastic eyes. 10 out of 29 eyes show the rapid astigmatic changes to the with-the-rule, while the remaining 19 to the against-the-rule astigmatism. (C) Corneal astigmatism change vector 1 month after botulinum toxin-A injection in patients with blepharospasm. In 21 eyes, astigmatic patterns change to against-the rule (right side, red) and in 8 eyes, to with-the-rule (left side, blue). Distance from center represents diopteric change.

• 

  Fig. 3 The change of corneal topography 1 month after botulinum toxin-A injection. An example of topographic change before (A) and 1 month after injection of botulinum toxin-A (B). This topographic pattern reveals with-the-rule astigmatism before treatment, but slowly changes into against-the-rule astigmatism after toxin injection.

• 

  Fig. 4 The mean corneal astigmatism before and 1, 6 months after injection of botulinum toxin-A in patients with blepharospasm. With-the-rule astigmatism decreases and against-the rule astigmatism increases at 1 month, but return to its original pattern 6 months after injection of toxin.

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