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Lee, Kim, and Kim: Botulinum Toxin for Palliative Treatment of Epiphora in Patients with Nasolacrimal Duct Obstruction
Original Article

J Korean Ophthalmol Soc 2007;48(10):1318-1322.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.10.1318

Botulinum Toxin for Palliative Treatment of Epiphora in Patients with Nasolacrimal Duct Obstruction

Jung Ho Lee, M.D.1, Dae Yune Kim, M.D.2, Kwang Soo Kim, M.D.1

1Department of Ophthalmology, Dongguk University Gyeongju Hospital, Gyeonbuk, Korea

2Department of Ophthalmology, Haenam Hospital, Jeonnam, Korea

Address Reprint requests to Dae Yune Kim, M.D., Department of Ophthalmology, Haenam Hospital, #948-1 Hae-ri, Haenam-eup, Haenam-gun, Jeonnam 506-807, Korea, Tel: 82-61-530-0114, Fax: 82-61-535-4117, E-mail: daeyun115@hanmail.net

Received 6 February 2007       Accepted 15 May 2007

Copyright © 2007 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To describe the use of botulinum toxin injection of the lacrimal gland for palliative treatment of epiphora secondary to nasolacrimal duct obstruction.

Methods

A prospective non-comparative interventional case series study was designed to include 13 patients with nasolacrimal duct obstruction. Under topical anesthesia botulinum toxin A (1-4unit) was injected into the palpebral lobe of the lacrimal gland via a transconjunctival approach. Patients underwent a Schirmer test and a subjective evaluation of their epiphora symptoms was performed at 0 (baseline), 1, 4 and 12 weeks after injection.

Results

Subjective epiphora scores improved in 10 out of the 13 patients (76.9%). Schirmer test results showed objective reduction in tearing from baseline but did not strongly correlate with the subjective epiphora scores. Transient ptosis were experienced by two patients.

Conclusions

Botulinum A toxin injection for palliative treatment of epiphora secondary to nasolacrimal duct obstruction is a simple, effective and safe treatment.

Keywords: Botulinum A toxin, Lacrimal gland, Nasolacrimal duct obstruction

References

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Figure 1.
Exposure of the palpebral portion of the right lacrimal gland using a Desmarres retractor.
jkos-48-1318f1.tif
Figure 2.
Right upper lid ptosis following botulinum A toxin injection
jkos-48-1318f2.tif
Table 1.
Details of patients included in the study
Case Age Sex BTX A dose Cx. Munk's scale
Preinjection Week 4 Week 12
1 67 M 4 ptosis 4 1 1
2 74 M 1 3 3 3
3 77 F 2 4 2 2
4 73 F 2 ptosis 4 2 2
5 69 M 1 4 2 3
6 73 F 2 4 3 4
7 82 M 2 4 4 4
8 77 M 2 4 0 0
9 71 M 2.5 4 1 1
10 70 F 2.5 4 1 2
11 70 F 2.5 4 2 1
12 72 F 2.5 4 2 2
13 74 M 2.5 4 1 2
Table 2.
Results of improvement in subjective scores and Schirmer test value following botulinum toxin injection
Total no. of patients Patients with improved subjective scores (%) Patients with improved Schirmer test values (%)
13 10 (76.9%) 9 (69.2%)
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