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Transconjunctival botulinum toxin offers an effective, safe and repeatable method to treat gustatory lacrimation
  1. Kevin Falzon,
  2. Martin Galea,
  3. Geraldine Cunniffe,
  4. Patricia Logan
  1. Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
  1. Correspondence to Dr Kevin Falzon, Ophthalmology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Republic of Ireland; kev.falzon{at}

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Gustatory lacrimation is an aberrant re-innervation following a peripheral facial palsy, associated with uncontrollable ipsilateral tearing while eating or in anticipation of a meal.1 Fibres from the seventh cranial nerve, destined originally for the submandibular ganglion, become misdirected to the pterygopalatine ganglion. As the lacrimal glands are innervated by cholinergic fibres, gustatory lacrimation after facial palsy can be successfully treated by intraglandular injections of botulinum toxin A (BTX-A) blocking the release of acetylcholine in cholinergic nerve terminals.2 We report on the successful transconjuntival injection of BTX-A (Dysport® 10U, Ipsen Ltd, Slough, UK), with 5-year follow-up, in three patients with unilateral gustatory lacrimation following Bell's palsy.

Case report

Patient 1, a 29-year-old woman, developed gustatory lacrimation 4 years after a left-sided Bell's palsy. Patient 2, a 42-year-old man, was diagnosed with gustatory lacrimation following a recovered Bell's palsy 4 years before presentation. Patient 3, …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.