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목적 : Injection of botulinum toxin type A (BTX-A) in the medial part of the eyelid was previously reported to decrease the amount of tear volume ejected at each blink and the ability to drain tears, favoring the maintenance of the teardrop which may benefit patients with dry eye. This study tested the hypothesis that BTX-A injection can not only improve dry eye signs and symptoms, but also reduce a level of tear matrix metalloproteinase (MMP)-9, serotonin.
방법 : In this prospective double-masked study, 26 patients with intractable severe dry eye (level 3 or 4) were randomized to BTX-A or control 1:1. In BTX-A group, patients were subcutaneously injected with BTX-A in each medial pretarsal orbicularis muscle of the upper and lower eyelid. In a control, normal saline was injected. Before and at two weeks, one, two, four months after injection, dry eye symptoms (OSDI), signs (T-BUT, Schirmer I test and corneal fluorescein staining score were assessed. A level of tear MMP-9 and serotonin was measured before and at one month after injection.
결과 : 26 patients were included with a mean age of 57.8 years. Up to 2 months after injection, the eyes in BTX-A group showed lower OSDI scores compared with control group(p=0.019). TBUT was found to be increased up to 2 months in BTX-A group (p=0.006). The CFS were significantly lower in BTX-A group up to 2 months (p=0.001), and the Schirmer I test showed better measurement in the same group up to 1 month (p=0.03, p=0.004). In addition, BTX-A reduced a level of tear MMP-9 and serotonin significantly one month after injection (p<0.001). There were no complications during the observations.
결론 : Our results are consistent with our hypothesis that BTX-A injection in the medial part of the lower and upper eyelid is an effective procedure that improves signs and symptoms of patients with dry eye and reduce a level of tear cytokines. However, the effect of BTX-A injection lasted only about two months. Further studies with a larger population will be needed to clarify the effect of BTX-A on dry eye syndrome.
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