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. Author manuscript; available in PMC: 2022 Apr 1.
Published in final edited form as: Orbit. 2021 Aug 15;41(2):150–161. doi: 10.1080/01676830.2021.1966810

Table 1.

Functional epiphora.

Author/Year Study Type # of Subjects Indications Injection Technique/Location Dosing Results Reported Side
Effects
Girard et al. (2018) Non-randomized, prosepective, intervention study 42 patients; 65 lacrimal glands; 18 males/24 females; Mean age 65 years • Paroxysmal lacrimal hypersection (n = 56, 86%)• Aberrant 7th nerve regeneration (n = 2, 3%)• Facial palsies (n = 7, 11%) Incobotulinum toxin A; transconjunctival direct injection into palpebral lobe of lacrimal gland Mean 4.9 Units; Range 2–10 units; Re-injections (n = 39, 60%) Munk Score mean reduction 2.68; Schirmer mean reduction of 9 mm; QoL questionnaire 88% (n = 37) satisfaction; epiphora resolution in 21% (n = 9) after first injection • ptosis (n = 2, 3%)• diplopia (n = 6, 9%)• lacrimal gland hematoma (n = 2, 3%)
Shan et al. (2019) Randomized, prospective, intervention study 15 patients; 4 males/11 females; mean age 38 years • Submandibular gland transplantation c/b epiphora (n = 15, 100%) Onabotulinum toxin A; Percutaneous injection into transplanted submandibular gland 3 groups of 5; 15, 20, & 25 Units; No re-injections reported Schirmer mean reduction 64/73/78% respectively; VAS (visual analogue scale) Scores decreased in 20&25 Unit groups through 6 months • None reported
Keegan et al. (2002) Non-randomized, prospective, intervention study 4 patients; 3 males/1 female; age range 20–58 • Aberrant 7th nerve regeneration (n = 3, 75%)• Submandibular gland transplant (n = 1, 25%) Abobotulinum toxin A; Transcutaneous lacrimal gland injection (n = 3, 75%); Subcutaneous injection near transplanted submandibular gland (n = 1, 25%) 20 Units in 3 divided doses; 1000–1200 units for submandibular injection; re-injections (n = 2, 50%) Schirmer improvement (n = 3, 75%); subjective improvement (n = 3, 75%) • ptosis (n = 2, 50%)• diplopia (n = 1, 25%)
Nava-Castañeda et al. (2006) Non-randomized, prospective, intervention study 15 patients; 15 lacrimal glands; 8 males/7 females; mean age 63 years • Gustatory epiphora (n = 15, 100%) Onabotulinum toxin A; transconjunctival direct injection into palpebral lobe of lacrimal gland 2.5 Units; no re-injections reported Schirmer test mean decrease 5.4 mm; statistically significant at 24 weeks in affected eyes • ptosis (n = 2, 13%)
Whittaker et al. (2003) Non-randomized, retrospective, intervention study 14 patients; 5 males/9 females; Mean age 60 years • Functional epiphora (n = 14, 100%) Onabotulinum toxin A; transconjunctival direct injection into palpebral lobe of lacrimal gland 2.5–5 Units; re-inections (n = 2, 14%) Pt reported symptom improvement @ 1 week (n = 10, 71%); @ 13 weeks (n = 8, 73%); Schirmer test value improvement @ 1 week (n = 11, 79%); @ 13 weeks (n = 6, 55%) • ptosis (n = 1, 7%)• diplopia (n = 1, 7%)
Hofmann (2000) Non-randomized, retrospective, intervention study • 2 patients • Aberrant 7th nerve regeneration (n = 2, 100%) Onabotulinum toxin A; transconjunctival direct injection into palpebral lobe of lacrimal gland 15 Units – 3 injections of 5 units each, 2 laterally subcutaneous and 1 transconjunctival glandular injection; re-injections (n = 2, 100%) Pt reported symptom improvement; observed lack of gustatory epiphora • None reported
Montoya et al. (2002) Non-randomized, prospective, intervention study • 4 patients; Mean age 57 years (range 35–75) • Gustatory hyperlacrimation (n = 4, 100%) Abobotulinum toxin A; transcutaneous (n = 3, 75%), transconjunctival (n = 1, 25%) direct injection into lacrimal gland 10 Units; re-injections (n = 3, 75%) Pt reported symptom improvement (n = 4, 100%); Schirmer decrease @ 6 months (n = 4, 100%) • ptosis (n = 1, 25%)• DES (n = 3, 75%)