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Long term efficacy and safety of botulinum toxin A injection for crocodile tears syndrome
  1. D E Barañano1,
  2. N R Miller2
  1. 1Departments of Neuroscience and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
  2. 2Wilmer Eye Institute, Division of Neuro-ophthalmology, Departments of Ophthalmology and Neurology, Johns Hopkins School of Medicine, Baltimore, MD USA
  1. Correspondence to: Dr Neil R. Miller MD Maumenee B-109, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, 21287, USA; nrmillerjhmi.edu

https://doi.org/10.1136/bjo.2003.029181

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    Gustatory lacrimation, also called crocodile tears syndrome (CTS), is an autonomic synkinesia in which patients tear excessively in response to salivary stimuli. It occurs most commonly in the setting of idiopathic or traumatic facial palsy and is thought to result from aberrant reinnervation of the lacrimal gland by salivary efferent fibres from either the seventh or ninth cranial nerve. Many patients tolerate CTS and require no intervention. For patients who cannot tolerate CTS, past treatments have included anticholinergic drugs, subtotal resection of the palpebral lobe of the lacrimal gland, and resection of the tympanic nerve proximal to the lesser superficial petrosal nerve. None of these approaches is optimal because of limited efficacy, morbidity, or both.

    Injection of botulinum toxin A has been shown to be effective for a host of disorders characterised by involuntary muscle spasms, including blepharospasm, hemifacial spasm, and torticollis. Botulinum toxin A also has been …

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