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Each patient was asked for dry eye symptoms occurring several times a week and lasting for more than half an hour before, 1 week, 1 month, and 3 months after injections.The quality of symptoms was classified as absent, minimal, moderate, or severe.Eight patients noticed no difference and five complained of worsening.Tear break up time was found to be increased 1 week and 1 month after injections.For rose bengal staining, one drop of 1% rose bengal solution was added to the inferior fornix and recorded in the temporal and nasal conjunctiva and cornea on a scale of 0 to 3 points according to the van Bijsterveld scoring system.Thus, the maximum score obtained for one eye was 9.

The Schirmer test was performed without anaesthesia using a commercially available 5 mm × 35 mm paper strip.When injected locally, it causes muscular paralysis by interfering with the release of acetylcholine at neuromuscular junctions.Many patients with blepharospasm also suffer from dry eye symptoms and have reduced Schirmer test values.Impression cytology showed no definite change in conjunctival cell morphology 1 month and 3 months after botulinum toxin A injections.Conclusion: In the patients presented here suffering from blepharospasm and dry eye, botulinum toxin A injections were effective in relieving blepharospasm but were not successful in treating dry eye syndrome. The light chain endopeptidase component of botulinum toxin acts in the end plate of motor neurons where it cleaves SNAP-25, a protein involved in the fusion of acetylcholine containing vesicles with the presynaptic membrane.

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