Abstract
Purpose
To review the published literature on botulinum toxin (BTX) for epiphora secondary to refractory lacrimal drainage disorders.
Methods
The authors performed a Pub Med search of all articles published in English on BTX injection into lacrimal gland for epiphora secondary to lacrimal drainage disorders. Relevant cross-references were obtained from the resultant studies. Data reviewed included demographics, indications, dose of BTX, number of injections, transconjunctival or transcutaneous route, outcomes and complications. Animal experiments of BTX into lacrimal gland were included and analyzed separately.
Results
Botulinum toxin injection into lacrimal gland, in animal studies, has shown to reduce the tear volume significantly lasting for approximately a month without any histological changes. The major indications have been refractory canalicular obstructions and functional epiphora. The commonly used dose was 2.5 U. Outcomes in the few studies published are encouraging with transient ptosis being the most common complication.
Conclusions
Botulinum toxin into the lacrimal gland is a minimally invasive alternative in cases of refractory epiphora secondary to lacrimal drainage disorders. In these subsets of patients, the reported concentrations, dosage and outcome measures are variable and need larger studies for standardization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Scott AB (1980) Botulinum toxin injection into extra ocular muscles as an alternative to strabismus surgery. Ophthalmology 87:1044
Naik MN, Soparkar CN, Murthy R, Honavar SG (2005) Botulinum toxin in ophthalmic plastic surgery. Indian J Ophthalmol 53:279–288
Boroojerdi B, Ferbert A, Schwarz M et al (1998) Botulinum toxin treatment of synkinesia and hyperlacrimation after facial palsy. J Neurol Neurosurg Psychiatry 65:111–114
Riemann R, Pfennigsdorf S, Riemann E, Naumann M (1999) Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report. Ophthalmology 106:2322–2324
Hofmann RJ (2000) Treatment of Frey’s syndrome (gustatory sweating) and ‘crocodile tears’ (gustatory epiphora) with purified botulinum toxin. Ophthal Plast Reconstr Surg 16:289–291
Falzon K, Galea M, Cunniffe G, Logan P (2010) Transconjunctival botulinum toxin offers an effective, safe and repeatable method to treat gustatory lacrimation. Br J Ophthalmol 94:379–380
Nava-Castã neda A, Tovilla-Canales JL, Boullosa V et al (2006) Duration of botulinum toxin effect in the treatment of crocodile tears. Ophthal Plast Reconstr Surg 22:453–456
Sellin LC (1985) The pharmacological mechanism of botulism. Trends in Pharma Sci 6:80–82
Whittaker KW, Matthews BN, Fitt AW, Sandramouli S (2003) The use of botulinum toxin A in the treatment of functional epiphora. Orbit 22:193–198
Tu AH, Chang EL (2005) Botulinum toxin for palliative treatment of epiphora in a patient with canalicular obstruction. Ophthalmology 112:1469–1471
Wojno TH (2011) Results of lacrimal gland botulinum toxin injection for epiphora in lacrimal obstruction and gustatory tearing. Ophthal Plast Reconstr Surg 27:119–121
Eustis HS, Baiuch A (2012) Use of botulinum toxin injections to the lacrimal gland for epiphora in children with proximal obstruction of lacrimal drainage system. J Pediatr Ophthalmol Strabismus 16:e15–e16
Ziahosseini K, Al-Abbadi Z, Malhotra R (2015) Botulinum toxin injection for the treatment of epiphora in lacrimal outflow obstruction. Eye (Lond) 29:656–661
Kaynak P, Karabulut GO, Ozturker C et al (2016) Comparison of botulinum toxin-A injection in lacrimal gland and conjunctivodacryocystorhinostomy for treatment of epiphora due to proximal lacrimal system obstruction. Eye (Lond) 30:1056–1062
Suwan-apichon O, Rizen M, Rangsin R et al (2006) Botulinum toxin B-induced mouse model of keratoconjunctivitis sicca. Invest Ophthalmol Vis Sci 47:133–139
Teymoortash A, Sommer F, Mandic R et al (2007) Intra-glandular application of botulinum toxin leads to structural and functional changes in rat acinar cells. Br J Pharmacol 152:161–167
Demetriades AM, Leyngold IM, D’Anna S et al (2013) Intra-glandular injection of botulinum toxin a reduces tear production in rabbits. Ophthal Plast Reconstr Surg 29:21–24
Kim JW, Baek S (2013) Functional and histologic changes in the lacrimal gland after botulinum toxin injection. J Craniofac Surg 24:1960–1969
Stanley EF, Drachman DB (1983) Botulinum toxin blocks quantal but not non-quantal release of ACh at the neuromuscular junction. Brain Res 261:172–175
Dartt D (2009) Neural regulation of lacrimal gland secretory processes: relevance in dry eye diseases. Prog Retin Eye Res 28:155–177
Stern ME, Beuerman RW, Fox RI et al (1998) The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea 17:584–589
Tarsy D, Bhattacharyya N, Borodic G (2000) Myasthenia gravis after botulinum toxin A for Meige syndrome. Mov Disord 15:736–738
Watts J, Brew B, Tisch S (2015) Myasthenia gravis exacerbation with low dose ocular botulinum toxin for epiphora. J Clin Neurosci 22:1979–1981
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Financial disclosure
Mohammad Javed Ali received support from the Alexander von Humboldt Foundation for his research, and he also receives royalties from Springer for the textbook ‘Principles and Practice of Lacrimal Surgery.’ Friedrich Paulsen was supported by Deutsche Forschungsgemeinschaft (DFG) Grants PA738/1-1–1-5 as well as PA738/2-1. He receives royalties from Elsevier for the anatomy atlas ‘Sobotta’ and a ‘Sobotta’ anatomy textbook.
Rights and permissions
About this article
Cite this article
Singh, S., Ali, M.J. & Paulsen, F. A review on use of botulinum toxin for intractable lacrimal drainage disorders. Int Ophthalmol 38, 2233–2238 (2018). https://doi.org/10.1007/s10792-017-0661-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-017-0661-9