Abstract
Purpose To establish the efficacy and safety of botulinum toxin in the treatment of Crocodile Tear Syndrome and record any possible complications.
Methods Four patients with unilateral aberrant VII cranial nerve regeneration following an episode of facial paralysis consented to be included in this study after a comprehensive explanation of the procedure and possible complications was given. On average, an injection of 20 units of botulinum toxin type A (Dysport®) was given to the affected lacrimal gland. The effect was assessed with a Schirmer’s test during taste stimulation. Careful recording of the duration of the effect and the presence of any local or systemic complications was made.
Results All patients reported a partial or complete disappearance of the reflex hyperlacrimation following treatment. Schirmer’s tests during taste stimulation documented a significant decrease in tear secretion. The onset of effect of the botulinum toxin was typically 24–48 h after the initial injection and lasted 4–5 months. One patient had a mild increase in his preexisting upper lid ptosis, but no other local or systemic side effects were experienced.
Conclusions The injection of botulinum toxin type A into the affected lacrimal glands of patients with gusto-lacrimal reflex is a simple, effective and safe treatment.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Notes
There are two commercially available preparations of BTX-A: BOTOX® which originated in the USA and Dysport® in the UK, both of which are available in the UK. There is no exact conversion factor between the two, but 1 U of BOTOX® is approximately equivalent to 3–6 U of Dysport®.
References
Chorobski J . The syndrome of crocodile tears. Arch Neurol Psych 1951; 65: 299–318
Axelsson A, Laage-Hellman J . The gusto-lachrymal reflex. Acta Otolaryngol 1962; 54: 239–254
McCoy FJ, Goodman RC . The crocodile tear syndrome. Plast Reconstr Surg 1979; 63: 58–62
Ramsay J, Taylor D . Congenital crocodile tears: a key to the aetiology of Duane’s syndrome. Br J Ophthalomol 1980; 64: 518–522
Sadjadpour K . Postfacial palsy phenomena: faulty nerve regeneration or ephaptic transmission?. Brain Res 1975; 95: 403–406
Boroojerdi B, Ferbert A, Schwarz M et al. Botulinum toxin treatment of synkinesia and hyperlacrimation after facial palsy. J Neurol Neurosurg Psychiatry 1998; 65: 111–114
Hofmann RJ . Treatment of Frey’s syndrome (gustatory sweating) and crocodile tears’ (gustatory epiphora) with purified botulinum toxin. Ophth Pl Recon Surg 2000; 4: 289–291
Reimann R, Pfennigsdorf S, Reimann E et al. Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland. Ophthalmology 1999; 106: 2322–2324
House JW, Brackmann DE . Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93: 146–147
Drobik C, Laskawi R . Frey’s syndrome: treatment with botulinum toxin. Acta Otolaryngol (Stockh) 1995; 115: 459–461
Schulze-Bonhage A, Schröeder M, Ferbert A . Botulinum toxin in the therapy of gustatory sweating. J Neurol 1996; 243: 143–146
Bjerkhoel A, Trobbe O . Frey’s syndrome: treatment with botulinum toxin. J Laryngol Otol 1997; 111: 839–844
Dutton JJ . Botulinum—a toxin in the treatment of craniocervical muscle spasms: short-and long-term, local and systemic effects. Surv Ophthalmol 1996; 41: 51–65
Borodic GE, Joseph M, Fay L et al. Botulinum toxin for thr treatment of spasmodic torticollis: dysphagia and regional toxin spread. Head and Neck 1990; 12: 392–398
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented as a poster at the Royal College of Ophthalmologists Congress 2000. The authors received no funding for this work
Rights and permissions
About this article
Cite this article
Montoya, F., Riddell, C., Caesar, R. et al. Treatment of gustatory hyperlacrimation (crocodile tears) with injection of botulinum toxin into the lacrimal gland. Eye 16, 705–709 (2002). https://doi.org/10.1038/sj.eye.6700230
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6700230
Keywords
This article is cited by
-
Comparison of botulinum toxin-A injection in lacrimal gland and conjunctivodacryocystorhinostomy for treatment of epiphora due to proximal lacrimal system obstruction
Eye (2016)
-
Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system
Journal of Neurology (2013)
-
Botulinumtoxin für die Behandlung sekretorischer Störungen im Kopf-Hals-Bereich
HNO (2012)
-
Botulinumtoxin bei Überfunktion der Tränendrüse, spastischem Entropium und Oberlidretraktion bei endokriner Orbitopathie
Der Ophthalmologe (2007)
