PURPOSE: To investigate the impact of botulinum toxin type A (BoNT-A) on neuropathic/nociplastic ocular pain (NOP) and identify predictors of patient outcomes. METHODS: A retrospective study of individuals with NOP symptoms (light sensitivity, wind/air sensitivity, persistent pain despite dry eye treatment) who received ≥1 BoNT-A injection. Primary outcome measures included if (responders vs. non-responders) and to what degree (none vs. mild vs. moderate vs. marked) individuals experienced pain improvement 4-6 weeks post-injection. Demographics and clinical exam information was compared between the groups. RESULTS: 27 individuals received BoNT-A for NOP symptoms. 74% (n=20) reported an improvement in pain and were classified as responders. Among responders, the degree of benefit varied, with 25% reporting mild, 45% moderate, and 30% marked pain improvement. Improvements in light sensitivity (37%), wind/air sensitivity (33%), and quality of life (QoL) (59%) were reported by fewer individuals. 80% of responders and 0% of non-responders reported QoL improvements afer BoNT-A. In a multivariable model that examined predictors of response (none to marked, 0-3), the presence of fibromyalgia (FM) (β=0.50
p=0.004) portended a better response, while shooting pain (β=-0.47
p=0.007) portended a worse response to BoNT-A, (full model r CONCLUSION: After BoNT-A, most individuals reported improved ocular pain and QoL, while fewer noted improved light and wind/air sensitivity. Some systemic and ocular factors predicted treatment response and may thus guide treatment.