Dry Eye Punctal Plug Aids Injectable Blepharospasm Treatment

A combined treatment of botulinum neurotoxin type A injection and absorbable punctal plug is more efficacious than injection alone in treating blepharospasm with severe dry eye.

The combined treatment of botulinum neurotoxin type A (BoNT-A) injection and absorbable dry eye punctal plug is more efficacious than BoNT-A alone in the treatment of patients with blepharospasm with severe dry eye symptoms, according to a study recently published in the Journal of Clinical Medicine.

Researchers conducted a retrospective consecutive cohort study to evaluate the clinical efficacy of the combined treatment of BoNT-A injection and dry eye punctal plug insertion on blepharospasm patients with dry eye. 

Investigators retrospectively recruited patients between January 2020 and May 2021. They evaluated efficacy according to the Jankovic rating scale, Ocular Surface Disease Index (OSDI), fluorescein staining (FL), fluorescein tear break-up time (FBUT) and Schirmer I test (SIT). They compared the changing rates ([after-before]/before) of each index between the groups.

For blepharospasm patients with severe dry eye symptoms, especially those with fluorescein staining in cornea, the combined treatment of BoNT-A and [punctal plug] is shown to be more effective compared with using BoNT-A alone.

The study included 29 right eyes from 29 patients with blepharospasm and dry eye manifestations, 17 patients who received BoNT-A injection (median age, 67 years; interquartile range [IQR], 58.5–73.0 years; 65% women and 35% men) and 12 patients who received BoNT-A plus APP treatment (median age, 64 years; IQR, 59.3–67.0 years; 75% women and 25% men). 

The researchers found that both BoNT-A and BoNT-A plus the dry eye punctal plug effectively reduced the severity and frequency of blepharospasm (P <.01 for all). They also observed improved OSDI, FL, FBUT and SIT after treatment in both groups (P <.01 or P <.05 for all). 

When comparing the BoNT-A group with the BoNT-A plus punctal plug group, the team found only the changing rates in OSDI (-52.23% vs -61.84%; P =.047) and FL (-22.55% vs -41.94%; P =.016) were significantly different between the groups. 

“For blepharospasm patients with severe dry eye symptoms, especially those with fluorescein staining in cornea, the combined treatment of BoNT-A and [punctal plug] is shown to be more effective compared with using BoNT-A alone,” the investigators report.

Limitations of the study included the retrospective, single-center design and small sample size.

References:

Ndikumukiza M, Xiao YT, Ye YF, et al. Botulinum neurotoxin type a injection combined with absorbable punctal plug insertion: an effective therapy for blepharospasm patients with dry eye. J Clin Med. 2023;12(3):877. doi:10.3390/jcm12030877