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

Abstract: 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 І test, fluorescein staining, (3) conjunctival impression cytology; and (4) multiplex cytokine immunobead assay.Results: The symptoms of DED + BEB were significantly different from DED controls and healthy controls. Cytokine analysis in tear fluid also showed that TNF- α, IL-1β, IL-6, IL-2, IL-17 and VEGF 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.