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  • Title: Treatment of gustatory hyperlacrimation (crocodile tears) with injection of botulinum toxin into the lacrimal gland.
    Author: Montoya FJ, Riddell CE, Caesar R, Hague S.
    Journal: Eye (Lond); 2002 Nov; 16(6):705-9. PubMed ID: 12439663.
    Abstract:
    PURPOSE: To establish the efficacy and safety of botulinum toxin in the treatment of Crocodile Tear Syndrome and record any possible complications. METHODS: Four patients with unilateral aberrant VII cranial nerve regeneration following an episode of facial paralysis consented to be included in this study after a comprehensive explanation of the procedure and possible complications was given. On average, an injection of 20 units of botulinum toxin type A (Dysport) was given to the affected lacrimal gland. The effect was assessed with a Schirmer's test during taste stimulation. Careful recording of the duration of the effect and the presence of any local or systemic complications was made. RESULTS: All patients reported a partial or complete disappearance of the reflex hyperlacrimation following treatment. Schirmer's tests during taste stimulation documented a significant decrease in tear secretion. The onset of effect of the botulinum toxin was typically 24-48 h after the initial injection and lasted 4-5 months. One patient had a mild increase in his preexisting upper lid ptosis, but no other local or systemic side effects were experienced. CONCLUSIONS: The injection of botulinum toxin type A into the affected lacrimal glands of patients with gusto-lacrimal reflex is a simple, effective and safe treatment.
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