Abstract Listings 2024

Purpose

To report the ocular surface disease features in patients with hemifacial spasm and review different aetiological hypotheses.

Methods

We conducted an observational study of patients with hemifacial spasm. All patients underwent an evaluation of ocular surface including Ocular Surface Disease Index (OSDI) questionnaire, corneal fluorescein staining, tear film break‐up time (TFBUT), corneal staining, and Schirmer test type I. These ocular surface parameters were measured in both homolateral and contralateral eyes in naive patients before botulinum A toxin injections or at least 3 months after toxin injections.

Results

Our serie included 51 patients with hemifacial spasm. The duration of the treatment with botulinum A injections ranged from 6 months to 15 years, with a mean of 7,3 years. Twenty patients had pathological OSDI score (39,2%). Six patients had (11%) a Superficial punctuate keratitis. Tear film instability was seen in 26,8%. The mean TFBUT was 7 seconds.

Conclusion

For several years now, there is increasing evidence of association between ocular surface disease and hemifacial spasm. Several hypotheses have been discussed, including tear film instability related to blinking abnormalities. This is supported by contralateral dry eye probably due to voluntary suppression of blinking to try to control the spasm. Most hypotheses are related to botulinum A toxin injections, as it may causes Meibomius gland dysfunction, lagophthalmos, reduction in blinking and decreased lacrimal secretion. However, the effect of botulinum injections can be beneficial. In fact, injections in the medial part of the orbicularis inhibits the lacrimal pump and improves symptoms of dry eye. Further studies with codified protocols for dosing, dilution and botulinum toxin administration techniques are needed to assess the real effect on the ocular surface in patients with hemifacial spasm.

Additional Authors

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