The electromyographic analysis of orbicularis oculi muscle in epiphora

Abstract

Purpose: Functional epiphora is a clinical condition that presents with the complaint of watery eyes, but without anatomical stenosis in the lacrimal drainage system. Although the mechanism is not clear, there are various possibilities involving the movement of the orbicularis oculi muscle, especially its deeper segment (Horner’s muscle). We aimed to evaluate the function of the orbicularis oculi muscle in patients with patent, but dysfunctional lacrimal drainage system using a quantitative motor unit potential (MUP) analysis. Methods: Twenty-eight patients with functional epiphora (mean age = 59 years) and a control group of 28 volunteers were included in the study. Inclusion criteria were persistent and symptomatic epiphora or wiping >10 times per day and diagnosis confirmation by lacrimal irrigation test. Electromyography (EMG) was performed on the deeper segment of the orbicularis oculi muscle (medial and lateral parts). MUP parameters (duration time, amplitude, number of phases, number of turns, area, rise time, and thickness) were evaluated in both groups. Any increase in amplitude, prolongation time (>14 ms), number of turns, and satellite potential was taken as characteristic of the neurogenic type of epiphora, whereas shortened motor unit duration time, increased phase number, and low amplitude are the features of myopathic type. Results: Upon MUP analysis of the medial and lateral orbicularis oculi muscle, the increase in duration and thickness values in the medial part and the increase in duration, amplitude, area, and thickness values of the lateral part were found to be statistically significant in the patient group compared to the control group ( P < 0.001). In the evaluation of the patients’ medial and lateral orbicularis oculi muscle, the increase in phase values and decrease in amplitude, area, and rise time values were found to be statistically significant ( P = 0.024, P < 0.001, P < 0.001, and P = 0.010, respectively). Conclusion: These data show that functional epiphora is due to neurogenic damage of the orbicularis oculi muscle and should be investigated in more detail.

Commentary: The electromyographic analysis of orbicularis oculi muscle in epiphora

“…The present study succinctly described the electromyographic response of the deeper heads of the orbicularis oculi muscle using the motor unit potential (MUP) analysis. [ 5 ] A statistically significant change in the amplitude, duration, number of phases, turns, and rise time were noted between the functional epiphora cohort and normal volunteers. The EMG was suggestive of a neurogenic origin of lacrimal pump weakness in patients with functional epiphora.…”