Botulinum Toxin to Lacrimal Gland

Botulinum injection to the lacrimal gland

Treatment of tearing depends on the etiology.  Reflex tearing is most effectively treated with optimization of the ocular surface; tearing secondary to eyelid malposition is treated with eyelid surgery; and lacrimal outflow obstruction is usually treated with lacrimal surgery.  There are instances in which patients continue to tear after optimization of the above three etiologies, and in situations that do not respond to the above treatments.  In those situations, botulinum toxin injection into the lacrimal gland can be very useful.  This results in decreased production of tears by the lacrimal gland.  This is usually temporary and often has to be repeated.   Also, there is the potential of the toxin diffusing to the extraocular muscles which could cause a temporary ptosis or diplopia. 

This is Richard Allen at oculosurg.com.  This video demonstrates injection of botulinum toxin to the lacrimal gland for epiphora.  This is a useful procedure in those patients who have epiphora and have failed previous lacrimal drainage surgeries, or in those patients with gustatory lacrimation.  In this video, the patient is under general anesthesia for an additional procedure.  The upper eyelid is everted and the lacrimal gland is identified superior laterally.  The injection is then placed in the palpebral lobe of the gland.  I usually place 2.5 to 5 units of type A botulinum toxin.  This is very effective in decreasing tear production.  It is important to stay lateral, as diffusion to the eyelid retractors or extraocular muscles could cause a temporary ptosis or double vision.