Abstract Listings 2024

Purpose

To report the influence of botulinum toxin A (BoNT-A) injections on basal tear production, as measured by Schirmer’s test with anaesthesia in patients seeking eyelid surgery.

Methods

Retrospective cohort of patients reviewed by a single clinician (RM) between January 2021 to April 2024, assessed with Schirmer test with anaesthetic. Demographic data and past ocular history, especially the presence or absence of prior BoNT-A treatment in the periocular region, was recorded. Patients who reported no history of periocular BoNT-A were designated as Group 1. Patients with a positive history for periocular BoNT-A were designated as Group 2. The proportion of eyes with Schirmer’s test with anaesthesia (basal tear production) test result <5mm (“low”), 5-9mm (“borderline”) and ≥10mm (“normal”) was compared between groups.

Results

722 eyes (361 patients) were included. Ages ranged from 17-93 years (mean 54.5), and 72.3% were female. Schirmer data in Group 1 was “low” in 32.9%, “borderline” in 26.4% and “normal” in 40.7%. In contrast, Group 2 had significantly lower test results (p≤0.05), with readings “low” in 44.2%, “borderline” in 27.9% and “normal” 27.9%.

Conclusion

Patients who had received BoNT-A injections had significantly lower Schirmer’s test with anaesthesia results, compared with patients who had never received BoNT-A. BoNT-A treatment for lateral canthal rhytids and upper face rejuvenation may be associated with an unintended effect of decreased basal tear production, and subsequent risk of dry eye. This may not be symptomatic but should be identified before considering aesthetic eyelid surgery.

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