title: A new treatment for epiphora secondary to submandibular gland transplantation: transcutaneous atropine gel.
abstract: OBJECTIVE
  To explore whether topical application of atropine gel controls epiphora secondary to submandibular gland (SMG) transplantion for severe keratoconjunctivitis sicca.
  
  
  METHODS
  Eighteen patients with epiphora after SMG transplantation participated in a double-blind, controlled, crossover study. Patients were treated with topical smear common atropine (CA) and modified atropine (MA) gels (intervals ≥1 day). The control effect of atropine gels was observed for 5 hours. Tear flow was quantified in resting and stimulated (after exercise) states using the Schirmer I test.
  
  
  RESULTS
  With the CA gel, tear flow decreased significantly at 10, 30, and 120 minutes. Average epiphora reduction rates (AERRs) were 22.37%, 18.14%, and 13.27%, respectively (P<.05). With the MA gel, tear flow decreased significantly from 5 minutes to 5 hours; AERRs increased from 24.06% to 42.67% (P<.05); Maximum efficacy was maintained from 15 minutes to 3 hours (P<.01); Tear flow gradually increased from 4 to 5 hours but was still lower than that before atropine use (P<.05). According to results of the Schirmer I test and AERRs, the control efficacy of the MA gel was significantly better than that of the CA gel (P<.05).
  
  
  CONCLUSIONS
  Topical application of atropine gel could effectively control mild epiphora for patients with SMG transplantation for severe keratoconjunctivitis sicca. The efficacy of MA gel was much better than that of the CA gel.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China; Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Peking University, Beijing, P.R. China.
authors.forename: Jian-Rui
authors.initials: JR
authors.lastname: Cai
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Shan
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China. Electronic address: czg4209@126.com.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Cai
authors.affiliation: School of Pharmaceutical Science, Peking University, Beijing, P.R. China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China.
authors.forename: Guang-Yan
authors.initials: GY
authors.lastname: Yu
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D001285:Atropine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005782:Gels; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000601:surgery*; D007766:Lacrimal Apparatus Diseases / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics / Q000008:administration & dosage; D013363:Submandibular Gland / Q000187:drug effects / Q000637:transplantation*; D013997:Time Factors; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005782:Gels; D010276:Parasympatholytics; D001285:Atropine
keywords: atropine; epiphora; hyperlacrimation; submandibular gland transplantation; transcutaneous administration