Current practice trends for lacrimal gland neurotoxin in the management of epiphora—a BOPSS survey

O’Rourke, Micheal; Cannon, Paul S.

doi:10.1007/s00417-021-05457-w

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…The results of this cadaver study indicate that ultrasound guidance can improve injection accuracy in the face, which might be of clinical value for facial surgeons. This, together with the fact that surgeons performing botulinum toxin injections are aware of the risk of complications, 46 might encourage the adoption of the suggested technique to reduce complications. Historic barriers to clinical implementation, such as availability and low resolution, 47 are shrinking as the technique is evolving and the field of ultrasound applications in plastic surgery is growing as a result.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Kildal

Rodríguez-Lorenzo

Pruidze

et al. 2023

Plastic &Amp; Reconstructive Surgery

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otulinum toxin injection is the accepted standard treatment for facial synkinesis and gustatory hyperlacrimation, two common and disabling sequelae of facial paralysis. Synkinesis, the involuntary movement of facial muscles occurring when other facial muscles are moved voluntarily, 1 leads to functional and social problems. 2 Gustatory hyperlacrimation (commonly known as crocodile tears syndrome), that is, excessive tear production when eating and Background: Botulinum toxin injection is the accepted standard treatment for synkinesis and gustatory hyperlacrimation in patients with facial paralysis. However, poor injection accuracy can result in inconsistent treatment outcomes, variable treatment durations, and complications. Ultrasound guidance should increase injection accuracy in the facial region; however, this has not been proven. Methods: Twenty-six hemifaces of nonembalmed cadavers were studied in a randomized split-face manner. Ink was injected with ultrasound or landmark guidance into the lacrimal gland and three common synkinetic muscles: the orbicularis oculi, depressor anguli oris, and mentalis. Injection accuracy was evaluated using several measures. Results: Using ultrasound guidance, most ink (>50%) was found inside the correct target in 88% of cases, compared with 50% using landmark guidance (P < 0.001). This was most pronounced in the lacrimal gland (62% versus 8%), depressor anguli oris (100% versus 46%), and mentalis (100% versus 54%) (P < 0.05). All ink was found inside the correct target (no ink outside) in 65% using ultrasound guidance versus 29% without (P < 0.001). Injection accuracy (any ink in target) was 100% when using ultrasound guidance versus 83% without (P < 0.01). Twenty-three percent of the landmark-guided depressor anguli oris injections stained the facial artery (P = 0.22). Conclusions: Ultrasound guidance significantly increased injection accuracy and reduced the amount of ink lost in the surrounding tissue compared with landmark guidance. Clinical trials are needed to explore the effects of ultrasound guidance on treatment outcome, duration, and complications in patients with facial paralysis.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Kildal

Rodríguez-Lorenzo

Pruidze

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…That said, the sample size is comparable with many existing studies (see Table, Supplemental Digital Content 1, available at http://links.lww.com/IOP/A384); It also highlights that even in a high-volume tertiary center, the numbers of patients undergoing this treatment modality are relatively small. As more experience is gained, 6 we look forward to gaining further insights into ideal dosing, which patients respond best, and the effects on reflex tearing and dry eye.…”

Section: Limitationsmentioning

confidence: 99%

“…First reported by Hofmann in 2000, 3 botulinum toxin A (BoNTA) injections to the lacrimal gland are a viable and increasingly popular option for treating epiphora 4 ; 90% of surveyed members of the British Oculoplastic Surgical Society reported the use of lacrimal gland BoNTA in their clinical practice, and it has been used successfully for prolonged periods of time. 5,6 Available as supplementary digital content is a table outlining the relevant studies. This highlights that most studies evaluating lacrimal gland BoNTA have been retrospective 3,[7][8][9][10][11] small series 3,7,9,[12][13][14][15] and focused on single etiologies such as gustatory epiphora (GE) secondary to facial nerve palsy 3,7,[12][13][14][15][16] or nasolacrimal outflow obstruction.…”

mentioning

confidence: 99%

Evaluating the Effectiveness of Lacrimal Gland Botulinum Toxin Using the TEARS Score

Hunt,

Schulz,

Malhotra

2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: Botulinum toxin (BoNTA) lacrimal gland injections are one treatment option for managing epiphora. Outcomes for epiphora in existing studies are subjective and lack grading. This study utilized validated grading instruments to evaluate the efficacy of BoNTA lacrimal gland injections. Methods: Prospective study evaluating the TEARS score and quality of life in patients receiving incobotulinum toxin (Xeomin) lacrimal gland injections for epiphora. Epiphora was graded using the TEARS score. Quality of life was evaluated using the watery eye quality of life score. Etiology, benefit duration, complications and additional injections were recorded. Results: Of the 28 patients, (median age 67.5 years), 19 (68%) had facial palsy gustatory epiphora (GE). Median effect duration was 13 weeks. Improvements in tearing frequency (T), clinical effects (E), and activity limitation (A) were seen in 57%, 57%, and 71% of patients, respectively. Median watery eye quality of life score improved from 42.4/100 ± 10.1 to 10.6 ± 15.5 (p < 0.001). Alongside crocodile tears, reflex tearing R-scores improved in 68% of patients with GE vs. 11% with non-GE causes (p = 0.004618). In total 89% of patients with GE and 56% with non-GE requested repeat injections. Self-reported percentage improvement ranged from 0% to 100% (median 60%, interquartile range 10%–76.25%). Conclusions: This is the first study reporting the outcomes of BoNTA lacrimal gland injections using validated TEARS and watery eye quality of life scores. Clinical and quality of life improvements are seen in most patients. Patients with GE achieve an additional improvement in dry eye-related reflex tearing alongside crocodile tears which both improve with BoNTA. TEARS data supports using BoNTA in these patients and is a useful validated grading instrument for epiphora.

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Management of Persistent Epiphora After Lacrimal Drainage Surgery

Quaranta Leoni,

Olver

2024

Oculoplastic, Lacrimal and Orbital Surgery

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Current practice trends for lacrimal gland neurotoxin in the management of epiphora—a BOPSS survey

Cited by 3 publications

References 29 publications

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors

Evaluating the Effectiveness of Lacrimal Gland Botulinum Toxin Using the TEARS Score

Management of Persistent Epiphora After Lacrimal Drainage Surgery

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