title: Comparison of botulinum toxin-A injection in lacrimal gland and conjunctivodacryocystorhinostomy for treatment of epiphora due to proximal lacrimal system obstruction.
abstract: PurposeTo investigate and compare the efficacy of botulinum toxin-A injection in the lacrimal gland and conjunctivodacryocystorhinostomy surgery for the treatment of epiphora caused by proximal lacrimal system obstruction.MethodsCharts of the patients with proximal canalicular obstruction who had undergone conjunctivodacryocystorhinostomy with permanent tube insertion (18 patients, group 1) or 4 units of botulinum toxin-A injection in the palpebral lobe of the lacrimal gland (20 patients, group 2) were reviewed retrospectively. The upper lacrimal system obstruction was diagnosed by lacrimal system irrigation. Schirmer-1 test and Munk epiphora grading for evaluation of epiphora were performed before the interventions and on tenth day, first, third, and sixth months after the interventions.ResultsImprovement of epiphora was statistically significant at all visits when compared with values before injection (P<0.001) in both of groups. When two techniques were compared, difference in degree of epiphora before and after intervention was not statistically significant (P<0.05). In group 2, none of the patients had punctate epitheliopathy, although there was a significant decrease in Schirmer test results (P<0.001, paired t-test). In group 1, 9 cases (50%) had tube dislocation, 4 cases (22.2%) had obstruction, and granuloma formation. Five cases (25%) had ptosis in group 2.Conclusion Conjunctivodacryocystorhinostomy requires surgical experience, special postoperative care, and multiple revisions. As botulinum toxin-A injection in the lacrimal gland is technically easy, less-invasive, safe, with reversible effects, it can be considered as an alternative treatment in patients with proximal lacrimal system obstruction.
authors.affiliation: Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
authors.forename: P
authors.initials: P
authors.lastname: Kaynak
authors.affiliation: Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
authors.forename: G O
authors.initials: GO
authors.lastname: Karabulut
authors.affiliation: Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Ozturker
authors.affiliation: Department of Ophthalmic Plastic and Reconstructive Surgery, Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Fazil
authors.affiliation: Department of Ophthalmology, Baskent University, Ankara, Turkey.
authors.forename: Y O
authors.initials: YO
authors.lastname: Arat
authors.affiliation: Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Perente
authors.affiliation: Department of Ophthalmology, Baskent University, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Akar
authors.affiliation: Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.
authors.forename: O F
authors.initials: OF
authors.lastname: Yilmaz
authors.affiliation: Istanbul Beyoglu Eye Research and Training Hospital, Galata, Istanbul, Turkey.|Faculty of Medicine, Department of Ophthalmology, Medeniyet University, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Demirok
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D007267:Injections; D007440:Intubation; D007765:Lacrimal Apparatus / Q000187:drug effects*; D007766:Lacrimal Apparatus Diseases / Q000188:drug therapy* / Q000209:etiology; D007767:Lacrimal Duct Obstruction / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A