Botulinum toxin treatment for hyperlacrimation secondary to aberrant regenerated seventh nerve palsy or salivary gland transplantation

Abstract

Aim: To investigate the potential of botulinum toxin A for treating hyperlacrimation. Methods: Three patients with unilateral symptoms of hyperlacrimation (diagnosed as "crocodile tearing") and one patient with a submandibular salivary gland transplant (SMGT) were studied. Tear production was quantified in the resting and stimulated (chewing or following exercise) state, using Schirmer's test and tear clearance. Lacrimal scintigraphy was used to assess outflow. Intraglandular injections (for patients with "crocodile tears") or periglandular injections (for the SMGT patient) of Dysport were administered in divided doses. Results: Two of the three eyes with reported gustatory lacrimation had a higher Schirmer test result than their fellow eye following gustatory stimulation. Scintigraphy, with and without stimulation, confirmed a patent drainage system in these patients. The other patient demonstrated a functional obstruction to tear flow. After treatment patients with confirmed gustatory lacrimation and the SMGT patient had a marked reduction in tearing at 2 weeks. This effect lasted 3-4 months. There was no demonstrable improvement in the patient with epiphora secondary to functional obstruction. Two patients who had received intraglandular injections developed a ptosis, which resolved spontaneously. Conclusions: This study illustrates that gustatory lacrimation is a difficult diagnosis. In post-facial nerve palsy a functional element must always be considered. However, in confirmed hyperlacrimation botulinum toxin treatment is effective but side effects may occur.

Avaliação do filme lacrimal de pacientes com distonia facial durante tratamento com toxina botulínica tipo A

“…Uma razão que poderia explicar os resultados encontrados no teste de BUT e de Schirmer é o fato de que a toxina botulínica pode ter um efeito farmacológico direto na produção de lágrima pela glândula lacrimal quando aplicada intraglandular, e com menor eficácia via subcutânea (10)(11) . A toxina botulínica tipo A afeta a transmissão colinérgica durante as manifestações sistêmicas do botulismo.…”

Aberrant facial nerve regeneration (AFR): an under-recognized cause of ptosis

“…7,8 The effect of botulinum toxin can last 3-4 months. 7 Although Boroojerdi et al 8 reported only focal side effects of Figure 2 Increase in ptosis and narrowing of the palpebral aperture on the affected side during cheek puffing.…”

Botulinumtoxin für die Behandlung sekretorischer Störungen im Kopf-Hals-Bereich

“…Es existieren 2 Injektionsverfahren: zum einen kann transkutan in mehreren Depots die Tränendrü-se behandelt werden [16,19], bei der anderen Technik erfolgt die Injektion transkonjunktival [1], wobei der Patient gebeten wird, mit dem behandelten Auge zur Nasenspitze zu blicken. Bereits mit recht niedrigen Dosierungen von 2,5 Einheiten Botox®, Fa.…”