The use of botulinum toxin A in the treatment of functional epiphora

Abstract

The results from this small pilot study are encouraging, although larger, controlled trials are needed to assess the optimal dose of BTX-A, its long-term efficacy and safety, and the role of multiple injections.

Comparison of botulinum toxin-A injection in lacrimal gland and conjunctivodacryocystorhinostomy for treatment of epiphora due to proximal lacrimal system obstruction

“…26 Several different doses and concentrations of BTA injection have been published in the literature (2.5-60 U). 4,[7][8][9][10][11][12][13][14][25][26][27][28] Higher doses seem to have no additional benefit in terms of efficacy and duration. 7,9 Wojno reported 63% improvement with 2.5U of BTA in patients with lacrimal obstruction, but 37% needed an additional 2.5U.…”

“…4,[8][9][10][11][12][13][14] Transconjunctival injection in the palpebral lobe of the lacrimal gland is usually preferred due to the ability to directly visualize the lacrimal gland during injection. 4,7,8,[11][12][13][14][25][26][27] However, transcutaneous injection in the orbital lobe was also reported. 9,10,28 Montoya et al 12 injected 20 U Dysport initially via transcutaneous route but later progressed to transconjunctival route because of the confidence that the entire amount of BTA was directly delivered to the lacrimal gland.…”

“…4,9,10,12,26 The most common complications of BTA injection in the lacrimal gland are blepharoptosis, diplopia, lagophthalmus, conjunctivitis, and dry eye. 4,7,[9][10][11][12][13][25][26][27][28] Demetriades et al 7 investigated the relationship among administered dose, reduced tear production, and associated side effects in an animal model. They injected 0.1 ml 0.625 U, 1.25 U or 2.5U BTA transconjunctivally in the lacrimal gland of one eye of white female rabbits and 0.1 ml of 0.9% sodium chloride in the contralateral lacrimal gland.…”

“…Upper eyelid was everted over Desmarres eyelid retractor. Patients were asked to look inferomedially and injection of 4 units of BTA, which was arbitrarily chosen under the guidance of previous studies, [8][9][10][11][12][13][14] via 30-gauge tuberculin syringe was performed in the palpebral lobe under direct visualization transconjunctivally. Tobramycin 0.2% eye drop was applied as a single dose after the injection.…”

“…7 Therefore injection of BTA in the lacrimal gland can be an alternative treatment in part for epiphora in lacrimal canalicular obstruction. Several reports about the use of BTA injection in the lacrimal gland for the treatment of gustatory hyperlacrimation, [8][9][10][11][12] gustatory sweating (Frey's Syndrome), 10 and functional epiphora 13 have been published in the literature. BTA injections in patients with epiphora owing to obstruction of lacrimal apparatus have been reported in a few reports.…”