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

Abstract

Purpose To investigate and compare the efficacy of botulinum toxin-A injection in the lacrimal gland and conjunctivodacryocystorhinostomy surgery for the treatment of epiphora caused by proximal lacrimal system obstruction. Methods Charts of the patients with proximal canalicular obstruction who had undergone conjunctivodacryocystorhinostomy with permanent tube insertion (18 patients, group 1) or 4 units of botulinum toxin-A injection in the palpebral lobe of the lacrimal gland (20 patients, group 2) were reviewed retrospectively. The upper lacrimal system obstruction was diagnosed by lacrimal system irrigation. Schirmer-1 test and Munk epiphora grading for evaluation of epiphora were performed before the interventions and on tenth day, first, third, and sixth months after the interventions. Results Improvement of epiphora was statistically significant at all visits when compared with values before injection (Po0.001) in both of groups. When two techniques were compared, difference in degree of epiphora before and after intervention was not statistically significant (Po0.05). In group 2, none of the patients had punctate epitheliopathy, although there was a significant decrease in Schirmer test results (Po0.001, paired t-test). In group 1, 9 cases (50%) had tube dislocation, 4 cases (22.2%) had obstruction, and granuloma formation. Five cases (25%) had ptosis in group 2. ConclusionConjunctivodacryocystorhinostomy requires surgical experience, special postoperative care, and multiple revisions. As botulinum toxin-A injection in the lacrimal gland is technically easy, less-invasive, safe, with reversible effects, it can be considered as an alternative treatment in patients with proximal lacrimal system obstruction.

Repeated injections of botulinum toxin-A for epiphora in lacrimal drainage disorders: qualitative and quantitative assessment

“…Ziahosseini et al [7] evaluated the effect of BTA injection for epiphora by the reduction of the mean Munk score after injection from 3.4 to 1.6 in the series with 22 eyes. Kaynak et al [8] reported both qualitative and quantitative evaluations of epiphora in a comparative study including 20 eyes treated with BTA injection: the mean Munk and Schirmer-1 scores were 3.95 and 12 mm before injection respectively, and decreased to 1.05 and 5.4 mm at 1 month after injection and to 1.36 mm and 5.8 mm at 3 months after injection, respectively. These results of previous studies were similar to our findings showing significant improvement of epiphora at 1 month and 3 months after BTA injection [3][4][5][6][7][8].…”

“…Several reports described the effects of injection of botulinum toxin-A (BTA) in the lacrimal gland in patients with epiphora [3][4][5][6][7][8]. BTA injection in the lacrimal gland decreases tear production by blocking presynaptic release of acetylcholine into the neuromuscular end plates of cholinergic nerve fibres [9].…”

Bilateral herpes simplex keratitis reactivation after lacrimal gland botulinum toxin injection

“…Lacrimal gland botulinum toxin A (BTA) injections successfully alleviate epiphora with documented improvement in Munk scores. [ 1 2 3 ] The toxin inhibits release of acetylcholine in all parasympathetic and cholinergic postganglionic sympathetic neurons, resulting in reduced tear secretion. [ 4 ] Injections are generally well tolerated and the side effects reported after this procedure are transient ptosis (7–25%) and diplopia (7%) in a few cases.…”

Botulinum Toxin- An Allrounder in the Ophthalmologist's Pharmacopoeia.

“…28,29 This is a less invasive procedure and requires less expertise. A transconjunctival approach is preferred.…”