Another Optometric Indication for Botox

HOT TOPIC

Consider Botox for Patients With Epiphora?

A recent paper published in Ophthalmic Plastic & Reconstructive Surgery showed that botulinum toxin (Botox) injections are an effective treatment option for epiphora, a notably problematic symptom to alleviate. This procedure is substantially less invasive than surgical intervention, which is often used to ease patient complaints.

The study was a meta-analysis of 19 studies that met rigorous inclusion criteria. It included data on 415 patients injected with Botox. At the 3-month follow-up, Schirmer test scores were reduced by a mean average of 8.8 mm, and at the 6-month follow-up, the improvement had regressed to 5.3 mm, likely due to the well-known effect of Botox “wearing off.” One substantial consideration that needs to be monitored in these patients is that Botox can diffuse away from the injection site up to 45 mm and cross anatomic barriers, such as the orbital septum. There is also a risk factor for the induction of ptosis in these patients. Of the study cases, 22% involved an adverse event, with ptosis being the most common (63%) and diplopia (21%) being the next most common.

Not only did the study show a significant improvement in Schirmer scores, but the subjective patient-reported outcomes also displayed significant improvements. Additionally, patients were pleased with the outcomes and found them to be beneficial.

My Two Cents

For those interested in the mechanism of action: Botox’s effect is thought to occur because of its inhibition of acetylcholine at the neuromuscular junction in the lacrimal gland, which causes a temporary reduced tear output due to the gland’s partial paralysis.

OUTSIDE THE LANE

Colon Cancer, Obesity on the Rise in the United States

The American diet is now being blamed for the suspiciously significant rise in colon cancer in the country, with almost 53,000 Americans expected to die of colorectal cancer just this year.

Researchers remind us that the risk of early-onset gastrointestinal cancer is strongly associated with obesity, which is also on the rise in the United States. (A 2019 study found that women who were considered obese had nearly twice the risk of developing early-onset colorectal cancer.) Additionally, it is expected that almost half of all US adults will be obese by 2030.

We know that obesity, along with other risk factors, including smoking, drinking alcohol, and eating the modern Western-style diet, can cause inflammation and higher levels of insulin that will increase the risk of cancer. Also interesting is the fact that American adults born in 1990 have twice the risk of developing colon cancer and nearly four times the risk of developing rectal cancer as those born in 1950.

My Two Cents

Colon cancer is likely to be a topic of considerable discussion in the years to come. I’ll admit I wasn’t aware that early-onset colorectal cancer has become the leading cause of cancer-related deaths in the United States for men under 50 years of age. Just this year, new research pointed out that a particular toxin found in the gut, known as colibactin (a product of a strain of the bacteria E. coli), can cause DNA damage in colon cells that leads to cancer formation). To me, this is yet another reminder to be more mindful of what I’m putting in my body and to incorporate more Mediterranean influences into my diet.

CAN YOU RELATE

I know I’ve shared this before, but I have pretty significant dry eye. When I was younger, I took Accutane, and my meibomian glands are absolute trash now (I’ll discuss this more in a future newsletter).

On a somewhat related note, my trainer recommended I do a “cleanse,” which is a first for me. Apparently going through this process can leave you dehydrated, but thanks to The Dry Eye Drink, I’ve mostly been able to stay on top of this. (This past week I was in northern Michigan for my family's yearly vacation, and there was little to no humidity.) Combine an arid environment with boating, campfires on the beach, and climbing dunes, and my eyes have been miserable. My left eye was so dry I had to use a disposable warm compress while sitting around the campfire, then douse my eyes in my favorite drop for dry eye to prevent evaporation.

I also used the samples of Optase Dry Eye Intense Drops that I received at Optometry’s Meeting, thanks to Barbara Watkins and Chris Whitehurst, which allowed me to get things under control. The whole process has reminded me of the significant effect dry eye can have on quality of life. I can’t function, enjoy family time, be a good father to my son Brooks, or live a comfortable life when my eyes are that dry. Special note: Scope Eyecare is releasing the Hylo-Forte drop, which is wildly popular in Europe, here in the states very soon.

QUOTE OF THE WEEK

“We’ve been wrong about what our job is in medicine. We believe our primary responsibility is to ensure health and survival. But really, it is larger than that: It is to enable well-being.”

— Atul Gawande, American surgeon and writer