Blepharospasm and periorbital edema after imatinib mesylate: improvement with botulinum toxin

Blefaroespasmo e edema periorbitário após mesilato de imatinibe: melhora com toxina botulínica

A 71-year-old man on treatment for chronic myeloid leukemia with imatinib mesylate presented with bilateral severe periorbital edema, including his eyelids, later progressing to blepharospasm (Figure A), and was referred to our Botulinum Toxin Outpatient Clinic two years ago. Hematological routine examinations, head and sinuses CT, brain MRI and CSF studies were normal. No treatment for dystonia had been done previously, including botulinum toxin. Botox^® (70U of onabotulinutoxinA, Allergan Inc., Irvine, CA, USA) was used for treatment of blepharospasm, with partial improvement (Figure B).

Figure.
Patient with severe periorbital edema associated with blepharospasm, secondary to treatment with imatinib mesylate. Imaging before (A) and after (B) botulinum toxin use. (With the patient’s permission).

Periorbital edema is a fairly common side effect of imatinib mesylate¹; however, the association with blepharospasm, and the treatment with botulinum toxin, has not been published². When the normal protective blink reflex becomes excessive, the ocular surface may be traumatized. The forceful and excessive eyelid blinking is not only debilitating but also results in further microtrauma to the ocular surface, further exacerbating the disease process. Patients with these conditions can present with chronic pain, photophobia, foreign body sensation, and secondary blepharospasm. Therefore, blepharospasm may be a symptom of ocular surface disease, and the use of botulinum toxin may be beneficial³.

References

• ¹
  Esmaeli B, Prieto VG, Butler CE, Kim SK, Ahmadi MA, Kantarjian HM, et al. Severe periorbital edema secondary to STI1571 (Gleevec). Cancer. 2002 Aug;95(4):881-7. https://doi.org/10.1002/cncr.10729
  » https://doi.org/10.1002/cncr.10729
• ²
  Simpson DM, Hallet M, Ashman EJ, Comella CL, Green MW, Gronseth G, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016 May; 86(19): 1818-26. https://doi.org/10.1212/WNL.0000000000002560
  » https://doi.org/10.1212/WNL.0000000000002560
• ³
  Yen MT. Secondary blepharospasm associated with ocular surface disease. Int Ophthalmol Clin. 2018 Winter; 58(1):71-5. https://doi.org/10.1097/IIO.0000000000000205
  » https://doi.org/10.1097/IIO.0000000000000205

Publication Dates

• Publication in this collection
  20 Jan 2020
• Date of issue
  Jan 2020

History

• Reviewed
  05 Mar 2019
• Reviewed
  03 May 2019
• Accepted
  03 May 2019