Botulinum toxin injection for the treatment of epiphora in lacrimal outflow obstruction.
OBJECTIVE
To describe our experience with the use of botulinum toxin (BoNTA) for the symptomatic treatment of lacrimal outflow obstruction.


METHODS
We retrospectively reviewed the case notes of patients with epiphora due to lacrimal outflow obstruction who chose to have injections of botulinum toxin into the palpebral lobe of the lacrimal gland instead of surgery between 2009 and 2014. Epiphora was graded subjectively with Munk scores obtained before and after treatment as well as qualitative degree of improvement reported by the patients. Severity and duration of side effects were also noted.


RESULTS
Seventeen patients (22 eyes, mean age 70.3, 4 males and 13 females) were identified. A mean of 3.5 (range; 1-10) injections of BoNTA (Botox, Allergan; 1.25-7.5 units) were given per eye. The mean interval between injections was 3.9 months (range 3-6). The mean Munk score (3.4, range 2-4) improved significantly after treatment to 1.6 (range: 0-3, P=0.0001 paired two-tailed t-test). Epiphora completely resolved in a fifth, improved by up to 60-90% in a half and only 'a little better' in a further fifth. Temporary bruising and diplopia (lasting 2 weeks) was reported in 12% (2/17).


CONCLUSIONS
We report our outcomes for BoNTA to the palpebral lobe of the lacrimal gland in patients with lacrimal outflow obstruction epiphora seeking alternatives to surgery. This data provide further evidence for informed consent and for commissioning organisations considering the funding of this treatment.
Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, West Sussex, UK.
K
K
Ziahosseini
Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, West Sussex, UK.
Z
Z
Al-Abbadi
Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, West Sussex, UK.
R
R
Malhotra
D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D007765:Lacrimal Apparatus / Q000187:drug effects; D007766:Lacrimal Apparatus Diseases / Q000188:drug therapy; D007767:Lacrimal Duct Obstruction / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000187:drug effects / Q000473:pathology; D012189:Retrospective Studies
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A