title: Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report.
abstract: OBJECTIVE
  Pathologic lacrimation (crocodile tears) is a rare but stigmatizing symptom after facial nerve paralysis. The aim of this pilot study was to examine whether botulinum toxin injection into the lacrimal gland is effective in reducing pathologic tear secretion.
  
  
  METHODS
  Case report.
  
  
  METHODS
  One patient who had crocodile tears after a zoster oticus infection received a botulinum toxin injection (2.5 mouse units) into the lacrimal gland.
  
  
  METHODS
  Before injection, 1 week, 1 month, and 6 months after injection, patient's lacrimation was assessed by a Schirmer test.
  
  
  RESULTS
  The lacrimation of the injected eye was reduced after 1 week and equal after 1 month when compared to the healthy side. After 6 months, hyperlacrimation reoccurred. No side effects were observed.
  
  
  CONCLUSIONS
  Intraglandular injection of botulinum toxin into the lacrimal gland may serve as a sufficient therapy for crocodile tears.
authors.affiliation: Department of Otorhinolaryngology/Head and Neck Surgery, University of Würzburg, Germany. randolf@mail.uni-wuerzburg.de
authors.forename: R
authors.initials: R
authors.lastname: Riemann
authors.forename: S
authors.initials: S
authors.lastname: Pfennigsdorf
authors.forename: E
authors.initials: E
authors.lastname: Riemann
authors.forename: M
authors.initials: M
authors.lastname: Naumann
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005154:Facial Nerve / Q000502:physiology; D005158:Facial Paralysis / Q000209:etiology / Q000503:physiopathology; D016697:Herpes Zoster Oticus / Q000150:complications; D006801:Humans; D007267:Injections; D007765:Lacrimal Apparatus / Q000187:drug effects* / Q000294:innervation / Q000378:metabolism; D007766:Lacrimal Apparatus Diseases / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000502:physiology; D009416:Nerve Regeneration; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D013666:Tears / Q000378:metabolism*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A