Results of Lacrimal Gland Botulinum Toxin Injection for Epiphora in Lacrimal Obstruction and Gustatory Tearing

Purpose: To describe the author's experience with the use of botulinum toxin (Botox, Allergan Inc., Irvine, CA, U.S.A.) injection in the palpebral lobe of the lacrimal gland for symptomatic epiphora due to lacrimal obstruction or gustatory tearing. Methods: This is a retrospective review of 46 patients treated by the author with botulinum toxin injection in the palpebral lobe of the lacrimal gland for symptomatic epiphora due to lacrimal obstruction or gustatory tearing from 2001 through 2008. All patients were injected with 2.5 units of botulinum toxin, and the patients' subjective responses were assessed 1 to 2 weeks later. If there was insufficient response, they were reinjected with an additional 2.5 units of botulinum toxin and re-evaluated in 1 to 2 weeks. The response to the treatment and complications were evaluated. Results: Overall, 74% of patients treated felt that tearing was mostly or completely improved. The only complication was temporary ptosis in 11% of the patients. Conclusion: Botulinum toxin injection in the palpebral lobe of the lacrimal gland can be used effectively and safely for symptomatic epiphora due to lacrimal obstruction and gustatory tearing. Although the beneficial results are temporary, the patient satisfaction in selected patients is high.