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Oman J Ophthalmol. 2019 May-Aug;12(2):104-107. doi: 10.4103/ojo.OJO_52_2018.

Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphora.

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Ophthalmic Plastic Surgery Services, L J Eye Institute, Ambala, Haryana, India.
Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India.
Department of Ophthalmic Plastic Surgery and Ocular Oncology, Advanced Eye Hospital and Institute, Navi Mumbai, Maharashtra, India.
Department of Orbit, Oculoplasty, Facial Aesthetics, Trauma and Reconstructive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India.



The purpose of this study is to assess the outcomes of lacrimal gland injections of botulinum toxin A (BoNTA) for epiphora secondary to lacrimal drainage disorders and functional epiphora.


This was a retrospective interventional case series where cases were divided into functional and nonfunctional epiphora.


A total of 37 eyes of 31 patients were identified: 13 males and 18 females. The mean age was 52 years (median = 53, range 29-86). The functional epiphora group had seven patients (8 eyes), subcategorized into hypersecretion (5), crocodile tears (1), and post seventh nerve palsy (1). Obstructive group (nonfunctional) had 24 patients (29 eyes), subcategorized into proximal canalicular block (12), common canalicular block (6), punctal stenosis (3), posttraumatic nasolacrimal duct obstruction (1), and partial nasolacrimal duct obstruction (1). Median preinjection Munk scores were similar in both groups (Grade 4). At 1 month, the median Munk score improved to 1 and 2 in functional and nonfunctional groups, respectively, after receiving a median dose of 4 units of BoNTA. Median reduction in Munk score was 75% in functional group versus 50% in nonfunctional group (P = 0.07). No difference in terms of complications was noted (transient ptosis).


Reduction in epiphora after lacrimal gland injection of botulinum toxin is seen in cases with functional epiphora as well as those with a physical obstruction in the lacrimal drainage pathway. While the symptomatic improvement was more in functional epiphora, the difference between the two groups was not statistically significant.


BOTOX; botulinum toxin; dacryocystorhinostomy; epiphora; facial palsy; functional; lacrimal obstruction; lacrimation; watering

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