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Photophobia and sensations of dryness in patients with migraine occur independent of baseline tear volume and improve following botulinum toxin A injections
  1. Ryan J Diel1,2,
  2. Jodi Hwang1,3,
  3. Zachary A Kroeger1,3,
  4. Roy C Levitt4,5,6,7,
  5. Constantine D Sarantopoulos4,5,
  6. Heather Sered1,
  7. Elizabeth R Felix1,8,
  8. Jasmine Martinez-Barrizonte1,
  9. Anat Galor1,4,5
  1. 1 Miami Veterans Administration Medical Center, Miami, Florida, USA
  2. 2 Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3 University of Miami Miller School of Medicine, Miami, Florida, USA
  4. 4 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
  5. 5 Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA
  6. 6 John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
  7. 7 John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
  8. 8 Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Anat Galor, Department of Ophthalmology, Miami VA medical center, Miami, Florida 33125, USA; agalor{at}


Background To evaluate the efficacy of botulinum toxin A (BoNT-A) in reducing photophobia and dry eye symptoms in individuals with chronic migraine. Additionally, we aimed to evaluate tear film volume as a potential contributor to symptoms in these patients.

Methods Retrospective review of 76 patients who received BoNT-A for chronic migraine between 23 August 2017 and 13 December 2017 at the Miami Veterans Affairs Medical Center Neurotoxin Clinic. Demographic data and all comorbidities were queried via chart review. Standardised validated surveys were administered to assess symptoms prior to and after BoNT-A injection. Preinjection tear volumes were obtained using the phenol red thread (PRT) test.

Results Preinjection migraine, photophobia and dry eye symptom scores were all significantly correlated, p<0.05, and none were associated with preinjection PRT results. After BoNT-A, improvements in migraine, photophobia and dry eye symptoms were also significantly correlated, p<0.05 and similarly did not associate with preinjection PRT results. Photophobia scores significantly improved following BoNT-A, while dry eye symptoms significantly improved in those with severe symptoms at baseline (DEQ-5 score ≥12), p=0.027. In logistic regression analysis of all individuals with dry eye symptoms (DEQ-5 ≥6), individuals with more severe dry eye symptoms were more likely improve, OR 1.27, 95% CI 1.06 to 1.51, p<0.01.

Conclusions BoNT-A significantly improved photophobia in patients being treated for migraine and also improved dry eye symptoms in patients with severe symptoms at baseline, independent of baseline tear film volume. These improvements may be due to modulation of shared trigeminal neural pathways.

  • cornea
  • epidemiology
  • treatment other

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  • Presented at Accepted as an oral presentation at the American Academy of Ophthalmology Annual Meeting, 2018.

  • Contributors All authors contributed to this manuscript: design and conduct of the study (RJD, JH, ZAK, HS, JM-B and AG), collection (RJD, JH and ZAK), management (RJD and AG), analysis (RJD and AG), interpretation of data (RJD, RCL, CDS, ERF and AG), preparation and review or approval of the manuscript (RJD, JH, ZAK, RCL, CDS, HS, ERF and AG).

  • Funding Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research EPID-006-15S (Galor), R01EY026174 (Galor), NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant; NIH NIDCR RO1 DE022903 and R21 NS105880 (Levitt) and the Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Miami VA IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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