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

PURPOSE: To study the influence of blepharospasm on dry eye disease by analyzing the clinical features, tear cytokine, and treatment response of patients with dry eye disease accompanied by benign essential blepharospasm. DESIGN: Prospective case series study. METHODS: Forty adults with a diagnosis of benign essential blepharospasm (BEB) and dry eye disease (DED) were consecutively recruited. Forty subjects with dry eye disease only and 40 healthy adults were recruited as eligible controls. A tear specimen was collected from all participants for cytokine analysis. The patients with benign essential blepharospasm were treated with botulinum neurotoxin type A. The main outcome measures were the following: (1) Ocular Surface Disease Index (OSDI) questionnaire; (2) clinical features, including tear break-up time (BUT), Schirmer I test, and fluorescein staining; (3) conjunctival impression cytology; and (4) multiplex cytokine immunobead assay. RESULTS: The symptoms of DED + BEB patients were significantly different from those of DED controls and healthy controls. Cytokine analysis in tear fluid also showed that tumor necrosis factor-a, interleukin (IL)1(3, IL-6, IL-2, IL-17, and vascular endothelial growth factor levels were significantly increased in DED + BEB patients. In treatment, botulinum neurotoxin type A injection effectively relieved blepharospasm in all of the DED + BEB patients. Moreover, in this group of patients, OSDI decreased significantly after the botulinum neurotoxin type A injection, and BUT was increased as well. CONCLUSION: BEB may participate in the progress of inflammation in DED + BEB patients. Botulinum neurotoxin type A injections could effectively relieve the symptoms of DED + BEB patients and improve their ocular surface condition.