Effects of Botulinum Toxin a Treatment on Ocular Surface in Patients with Entropion

Yıl 2025, Cilt: 8 Sayı: 2, 71 - 81, 28.08.2025

Mehmet Can Özen , Murat Oklar , Mustafa Talan , Titap Yazıcıoğlu , Şaban Şimşek

Öz

OBJECTIVE: This study aims to investigate the effects of Botulinum toxin A (BTA) and surgical intervention on the ocular surface in patients with entropion.
MATERIALS and METHODS: This is a prospective case-control study. The patients who have entropion (senile and spastic) are treated with BTA or surgical operation (Jones Procedure). Tear break up time (TBUT), ocular surface disease index (OSDI) score, Schirmer I test, and Oxford scale were analyzed at the outset and one and three months after the procedure.
RESULTS: Fifty patients (23 males, 27 females; mean age 65.04 ± 6.97 years) participated in the study. Significant improvements were observed in TBUT, OSDI, Schirmer I, and Oxford scores after both BTA and surgery. No difference was found in TBUT between the first and third month. OSDI scores were significantly lower in the group at both time points (p=0.039, p=0.049). Schirmer I was higher in the surgery group at the third month (p=0.040), while the BTA group had lower Oxford scores at the first month (p=0.037), with no difference at the third month.
CONCLUSION: BTA application is an effective and safe method to improve ocular surface parameters in the treatment of entropion. The fact that some of these effects are superior to the surgical method may cause BTA application to be preferred in patients with ocular surface disorders.

Anahtar Kelimeler

Anterior segment , botulinum toxin A , entropion , eyelid

Etik Beyan

The study followed the principles outlined in the Declaration of Helsinki and received approval from the ethics committee Kartal Lütfi Kırdar City Hospital (28.01.2022- 2022/514/218/11).

Entropiyonlu Hastalarda Botulinum Toksin A Tedavisinin Oküler Yüzey Üzerindeki Etkileri

Öz

AMAÇ: Bu çalışmanın amacı entropiyonlu hastalarda Botulinum toksin A (BTA) ve cerrahi müdahalenin oküler yüzey üzerindeki etkilerini araştırmaktır.
GEREÇ ve YÖNTEM: Çalışma prospektif ve vaka-kontrol tipindedir. BTA ve cerrahi (Jones Prosedürü) uygulanan entropionlu (senil ve spastik) hastalarda gözyaşı kırılma zamanı (TBUT), oküler yüzey hastalık indeksi (OSDI) skoru, Schirmer I testi, Oxford skalası başlangıçta ve işlemden bir ve üç ay sonra analiz edildi.
BULGULAR: Elli hasta (23 erkek, 27 kadın; ortalama yaş 65,04±6,97 yıl) çalışmaya dahil edildi. Hem BTA hem de cerrahi sonrasında TBUT, OSDI, Schirmer I ve Oxford skalasında anlamlı iyileşmeler gözlendi. TBUT’de birinci ve üçüncü aylar arasında fark bulunmadı. OSDI skorları her iki zaman diliminde de BTA grubunda anlamlı olarak daha düşüktü (p=0,039, p=0,049). Schirmer I üçüncü ayda cerrahi grupta daha yüksekken (p=0,040), BTA grubunun Oxford skorları birinci ayda daha düşüktü (p=0,37), üçüncü ayda ise fark yoktu.
SONUÇ: BTA uygulaması entropiyon tedavisinde oküler yüzey parametrelerini iyileştirmek için etkili ve güvenli bir yöntemdir. Bu etkilerin bazılarının cerrahi yönteme göre daha üstün olması oküler yüzey bozukluğu olan hastalarda BTA uygulamasının tercih edilmesine neden olabilir.

Anahtar Kelimeler

Botilinum Toksin A , Entropiyon , Göz Kapağı , Ön Segment

Etik Beyan

Çalışma Helsinki Bildirgesi’nde belirtilen ilkelere uygun olarak yürütüldü ve etik kurul onayı alındı. Kartal Lütfi Kırdar Şehir Hastanesi (28.01.2022-2022/514/218/11).

Kaynakça

• 1. American Academy of Ophthalmology Basic Clinical and Science Course, Section 7, Orbit, Eyelids, and Lacrimal System. 2019-2020; 148-154.
• 2. Pereira MG, Rodrigues MA, Rodrigues SA. Eyelid entropion. Semin Ophthalmol. 2010; 25: 52-58.
• 3. Marcus MM, Paul PO, Jimmy SML. Involutional entropion: Risk factors and surgical remedies. Curr Opin Ophthalmol. 2015; 26: 416-421.
• 4. Olver JM, Barnes JA: Effective small-incision surgery for involutional lower eyelid entropion. Ophthalmology. 2000; 107: 1982-1988.
• 5. Skorin L Jr, Norberg S, Erickson JA. Entropion: etiology, classification, diagnosis, and treatment. Consultant. 2018; 58: 325-335.
• 6. Lin P, Kitaguchi Y, Mupas-Uy J, Sabundayo MS, Takahashi Y, Kakizaki H. Involutional lower eyelid entropion: causative factors and therapeutic management. Int Ophthalmol. 2019; 39: 1895-1907.
• 7. Osaki T, Osaki MH, Osaki TH. Temporary management of involutional entropion with octyl-2-cyanoacrylate liquid bandage application. Arq Bras Oftalmol. 2010; 73: 120- 124.
• 8. Babuccu O. An alternative approach for involutional entropion: a preliminary study. Lasers Med Sci. 2012; 27: 1009-1012.
• 9. Jankovic J. Botulinum toxin in clinical practice. J Neurol Neurosurg Psychiatry. 2004; 75: 951-957.
• 10. Dutton JJ, Fowler AM. Botulinum toxin in ophthalmology. Surv Ophthalmol. 2007; 52: 13-31.
• 11. Zhang SY, Yan Y, Fu Y. Cosmetic blepharoplasty and dry eye disease: a review of the incidence, clinical manifestations, mechanisms and prevention. Int J Ophthalmol. 2020; 13: 488-492.
• 12. Gomes JA, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017; 15: 511-538.
• 13. Pacella SJ, Codner MA. Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show. Plast Reconstr Surg. 2010; 125: 709-718.
• 14. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, Gupta PK, Karpecki P, Lazreg S, Pult H, Sullivan BD, Tomlinson A, Tong L, Villani E, Yoon KC, Jones L, Craig JP. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017; 15: 539-574.
• 15. Papas EB. Diagnosing dry-eye: Which tests are most accurate? Cont Lens Anterior Eye. 2023; 46: 102048.
• 16. Jones LT, Reeh MJ, Wobig JL. Senile entropion. A new concept for correction. Am J Ophthalmol. 1972; 74: 327- 329.
• 17. Iozzo I, Tengattini V, Antonucci VA. Senile lower lid entropion successfully treated with botulinum toxin A. J Cosmet Dermatol. 2016; 15: 158-161.
• 18. Christiansen G, Mohney BG, Baratz KH, Bradley EA. Botulinum toxin for the treatment of congenital entropion. Am J Ophthalmol. 2004; 138: 153-155.
• 19. Ashena Z, Webber S. Acquired lateral upper lid entropion in a child treated with Botulinum toxin. Eye (Lond). 2012; 26: 1390-1391.
• 20. Neetens A, Rubbens MC, Smet H. Botulinum A-toxin treatment of spasmodic entropion of the lower eyelid. Bull Soc Belge Ophtalmol. 1987; 224: 105.
• 21. WEE, Syeo Young; PARK, Eun Soo. Immunogenicity of botulinum toxin. Archives of plastic surgery. 2022; 49.01: 12-18.
• 22. Bergstrom R, Czyz CN. Entropion. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-
• 23. Leszczynska, Anna; Nowicka, Danuta1; Pillunat, Lutz E; Szepietowski, Jacek C. Five decades of the use of botulinum toxin in ophthalmology. Indian Journal of Ophthalmology. 2024; 72: 789-795.
• 24. Lanzl I, Merté RL, Poimenidou M. Botulinumtoxin- Injektionen bei senilem Entropium [Botulinum toxin injections for senile entropium]. Klin Monbl Augenheilkd. 2015; 232: 37-39.
• 25. Jariyakosol S, Uthaithammarat L, Chatwichaikul N, Kasetsuwan N, Chongpison Y. Dry Eye Disease in Hemifacial Spasm Patients Treated with Botulinum Toxin Type A. Clin Ophthalmol. 2021; 15: 1775-1782.
• 26. Sanguandikul L, Apinyawasisuk S, Jariyakosol S, Hirunwiwatkul P, Chongpison Y. Complications of Preseptal Versus Pretarsal Botulinum Toxin Injection in Benign Essential Blepharospasm: A Randomized Controlled Trial. Am J Ophthalmol. 2021; 232: 9-16.
• 27. Serna-Ojeda JC, Nava-Castaneda A. Paralysis of the orbicularis muscle of the eye using botulinum toxin type A in the treatment for dry eye. Acta Ophthalmol. 2017; 95: e132-e137.
• 28. Kakizaki H, Zako M, Miyaishi O, Nakano T, Asamoto K, Iwaki M. The lacrimal canaliculus and sac bordered by the Horner’s muscle form the functional lacrimal drainage system. Ophthalmology. 2005; 112: 710-716.
• 29. Sahlin S, Chen E, Kaugesaar T, Almqvist H, Kjellberg K, Lennerstrand G. Effect of eyelid botulinum toxin injection on lacrimal drainage. Am J Ophthalmol. 2000; 129: 481- 486.
• 30. Jeffers J, Lucarelli K, Akella S, Setabutr P, Wojno TH, Aakalu V. Lacrimal gland botulinum toxin injection for epiphora management. Orbit. 2022; 41: 150-161.
• 31. Pattanayak S, Sharma PK, Samikhya S, Khuntia I, Patra K. Transconjunctival botulinum toxin injection into the lacrimal gland in crocodile tears syndrome. Indian J Ophthalmol. 2022; 70: 1339-1342.
• 32. Lee SJ, Rim TH, Jang SY, Kim CY, Shin DY, Lee EJ, Lee SY, Yoon JS. Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections. Graefe's Archive for Clinical and Experimental Ophthalmology. 2013; 251: 261-270.
• 33. Monga P, Gupta VP, Dhaliwal U. Clinical evaluation of changes in cornea and tear film after surgery for trachomatous upper lid entropion. Eye. 2008; 22: 912-917.
• 34. Ceylan NA, Yeniad B. Effects of Upper Eyelid Surgery on the Ocular Surface and Corneal Topography. Turk J Ophthalmol. 2022; 52: 50-56.
• 35. Yan Y, Zhou Y, Zhang S, Cui C, Song X, Zhu X, Fu Y. Impact of full-incision double-eyelid blepharoplasty on tear film dynamics and dry eye symptoms in young Asian females. Aesthetic Plastic Surgery. 2020: 1-8.
• 36. Krachmer. (2013). Cornea, 3rd Edition. Elsevier. 37. Demetriades AM, Leyngold IM, D’Anna S, Erghari AO, Emmert DG, Grant MP et al. Intraglandular injection of Botulinum Toxin A reduces tear production in rabbits. Ophthal Plast Reconstr Surg. 2013; 29: 21-24.
• 38. Miller KL, Walt JG, Mink DR, et al. Minimal Clinically Important Difference for the Ocular Surface Disease Index. Arch Ophthalmol. 2010; 128: 94-101.
• 39. Bayraktar Bilen N, Bilen Ş, Topçu Yılmaz P, Evren Kemer Ö. Tear meniscus, corneal topographic and aberrometric changes after botulinum toxin-a injection in patients with blepharospasm and hemifacial spasm. Int Ophthalmol. 2022; 42: 2625-2632.
• 40. Choi EW, Yeom DJ, Jang SY. Botulinum Toxin A Injection for the Treatment of Intractable Dry Eye Disease. Medicina (Kaunas). 2021; 57: 247.