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Can hemifacial spasm lead to glaucomatous changes?
K K H Lai1, A Tsang1, A K T Kuk1
1Department of Ophthalmology, Tung Wah Eastern Hospital, 19 Eastern Hospital Road, Causeway Bay, Hong Kong.
Insights
Hemifacial spasm patients with glaucoma required higher Botox dosages, linked to elevated intraocular pressure. Further research is needed to understand if hemifacial spasm causes glaucoma progression.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Hemifacial spasm (HFS) is a neurological condition characterized by involuntary contractions of facial muscles.
- Glaucoma is a group of eye conditions that damage the optic nerve, often associated with elevated intraocular pressure (IOP).
- Botulinum toxin (Botox) injections are a common treatment for HFS.
Purpose of the Study:
- To investigate the association between hemifacial spasm and glaucoma.
- To evaluate if glaucoma diagnosis in HFS patients correlates with the required Botox dosage.
- To explore the relationship between Botox dosage, intraocular pressure, and glaucoma in HFS patients.
Main Methods:
- Retrospective review of clinical and procedural records.
- Analysis of data from 76 consecutive patients with HFS treated with Botox.
- Comparison of Botox dosage, intraocular pressure, and glaucoma status between patient groups.
Main Results:
- 13% of HFS patients studied were diagnosed with glaucoma (POAG and CACG).
- Glaucoma patients required significantly higher Botox dosages (31±8 units vs. 26±7 units).
- A positive correlation was found between presenting intraocular pressure and required Botox dosage (R=0.31, P=0.0116).
Conclusions:
- Hemifacial spasm patients diagnosed with glaucoma tend to require higher Botox dosages.
- Elevated presenting intraocular pressure is associated with increased Botox dosage requirements in HFS patients.
- The potential causal link between hemifacial spasm, intraocular pressure fluctuations, and glaucomatous damage warrants further investigation.
Purpose:
To evaluate the association between hemifacial spasm (HFS) patients and glaucoma as a function of the Botox dosage required.
Methods:
A retrospective review of clinical documents and procedure records.
Results:
Information of 76 consecutive patients (58 females) with HFS who received Botox treatment were reviewed. The age at onset of HFS was 66±11 (32-85) years, and all manifested unilaterally. Ten (13%, 95% confidence interval: 6.5-22.9%) patients were diagnosed with glaucoma, including 8 primary open-angle glaucoma (POAG) (4 unilateral and ipsilateral to the HFS), and 2 bilateral chronic angle-closure glaucoma (CACG). Nine of the 10 patients developed glaucoma after the onset of the HFS. The Botox dosage was significantly higher among those diagnosed with glaucoma (31+/8 vs. 26+/7units, P<0.05). There was a positive relationship between the presenting intraocular pressure (IOP) and the Botox dosage required (R=0.31, P=0.0116). However, there was a weak relationship between the Botox dosage required and the vertical cup to disc ratio (R=0.076, P=0.525). The presenting IOP of the HFS-affected eyes in those diagnosed with glaucoma was higher than those without glaucoma (19±3.5 vs. 13±3.2mmHg, P=<0.05). The presenting IOP between the HFS-affected and unaffected eyes was similar (16±4.8 vs. 15+/4.6mmHg, P=0.430). Smoking status, history of diabetes mellitus, hypertension, hyperlipidemia and obstructive sleep apnea were not different between HFS patients with or without glaucoma.
Conclusions:
Hemifacial spasm patients with glaucoma were associated with a higher Botox dosage. We found a positive relationship between the Botox dosage required and the presenting IOP. Whether hemifacial spasm can result in fluctuation of IOP, eventually causing glaucomatous damage, remains to be studied further.
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