Disclosures: Krupali Chokshi, MD: No financial relationships or conflicts of interest

Case Diagnosis: Migraines, Eye pain and photophobia

Case Description or Program Description: A 64-year-old female presented to pain clinic for follow up for her migraines for which she periodically received Botulinum toxin injections for 1 year with moderate improvement. On follow-up she presented with new onset bilateral eye pain and photophobia that began 1 month prior associated with her usual headache pain. Past medical history included fibromyalgia, trigeminal neuralgia, hypertension, glaucoma, cataracts and an episode of uveitis 8 years prior. Opthalmology was consulted – uveitis was ruled out on exam. She underwent Botulinum toxin injections for her migraines. 10 units were injected into the bilateral corrugators, 5 units into the procerus, and 20 units into the frontalis muscle, 40 units into the temporalis, 30 units into the occipitalis, 20 units into the bilateral cervical paraspinals and 30 units into the trapezius. She tolerated the procedure well, reported improvement in her migraines and resolution of her eye pain on follow up.

Setting: Outpatient musculoskeletal clinic

Assessment/Results: Botulinum toxin injections have many ophthalmologic uses including blephaospasm, meige syndrome, hemifacial spasm, strabismus and eye retraction.

Discussion (relevance): 3.3 million adults suffer from chronic migraines and botulinum toxin injections serve as an effective therapeutic intervention to reduce the number of headache days a patient may have as well as their intensity. These migraines may often be associated with visual pain or disturbances which can also potentially be alleviated with our intervention. Other ophthalmologic uses of Botox include blepharospasm, meige syndrome, hemifacial spasm, strabismus and eye retraction. One retrospective study, published in the Journal of Ophthalmology, found migraine, photophobia and dry eye symptom scores all significantly improved after a trial of Botulinum toxin injections.

Conclusions: Botulinum toxin injections serve as a effective therapeutic intervention for atypical eye pain. Further research is needed to understand clinically effective dosage of Botox, sites, number of injections and treatment timeline.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/more-than-meets-the-eye-successful-treatment-of-eye-pain-with-botulinum-toxin-injections/