Click here to go back to listing page
Abstract ID: 24-158
Botulinum toxin as an alternative treatment to conjunctivodacryocystorhinostomy
Suzana Matayoshi
Purpose
Upper lacrimal pathway obstruction can lead to epiphora. The standard treatment is surgical through conjunctivodacryocistorhinostomy (CDCR) with the insertion of a Lester Jones Pyrex glass. This procedure has several complications.
Injection of type A botulinum toxin (BT) into the lacrimal gland blocks acetylcholine’s presynaptic secretion, decreasing tear production.
To evaluate the effectiveness of botulinum toxin as a treatment for epiphora as an alternative to conjunctivodacryocystorhinostomy
Methods
It is a retrospective study. We enrolled patients undergoing ABT application to the lacrimal gland with epiphora complaints caused by upper lacrimal system obstruction.
We injected transconjunctivally BT at the palpebral lacrimal gland (Botox 2.5 units or Dysport 7.5 units).
In patients who reported a slight improvement in symptoms, we repeated the injection after 14 days (same dose).
Measured outcomes: Test Schirmer, Milder, and patient subjective perception.
The Paired T-Test was used for statistical analysis of results.
Results
We included twenty-five patients (31 eyes) in the study.
In the subjective evaluation of the treatment, there was complete improvement of symptoms in 26 eyes (83.87%) and partial improvement in 5 (16.12%)—total improvement after reapplication in these five eyes.
In the Schirmer test, there was an average improvement of 5.19 mm (+/- 8.68; p < 0.005) from (19.25mm) until reassessment 14 days later (14.06mm).
In the Milder test: mean improvement of 17.92 mm (+/- 14.46; p < 0.005) between the tear meniscus pre and post procedure
Eyelid ptosis, observed in 7 (22.58%) of the treated eyes, was the only complication reported and was transient, with complete resolution after two months.
Conclusion
The use of botulinum toxin to treat epiphora has demonstrated favorable results and can benefit patients who do not wish or cannot undergo CDCR.
Additional Authors
Janaina Brabo – Sao Paulo University Medicine School
Rodolfo Bonatti – Sao Paulo University Medicine School
Mateus Menon – Sao Paulo University Medicine School
Marco Aurelio Komatsu – Sao Paulo University Medicine School