Role of Botulinum toxin-A for epiphora in lacrimal drainage disorders:interventional case series (Preprint)

BACKGROUND • Obstruction of the tear drainage system is one of the most common causes of epiphora, and surgical procedures have been the standard treatments. • Several reports described the effects of injection of BTA in the lacrimal gland in patients with epiphora. • However, there have been few previous studies that quantitatively assessed the effect of BTA injection. • Transconjunctival injection of BTA in the lacrimal gland shows favourable outcomes for epiphora without permanent complications. • Injections has consistent efficacy and duration of effect, and BTA injections can be repeated for symptomatic epiphora as an alternative to complex surgery OBJECTIVE • To report the outcome of botulinum toxin-A (BTA) injections in the lacrimal glands in patients with epiphora. • To study effectivness of lacrimal gland injections of botulinum toxin A for epiphora secondary to lacrimal drainage disorders METHODS • This will be a prospective, interventional case series to be conducted in Acharya vinoba rural hospital, Sawangi, Wardha. • Demographic information, previous medical history, aetiology of epiphora, clinical information needed for epiphora assessment, treatment information, outcomes, and complications will be noted. • Each patient will undergo lacrimal system examination at presentation that included lacrimal irrigation and diagnostic probing, and dacryocystography if needed. • INCLUSION CRITERIA- proximal canalicular obstruction, functional nasolacrimal duct obstruction (NLDO), and inoperable general condition. • EXCLUSION CRITERIA- Hyperscretion, crocodile tears, lacrimal pump failure due to 7th nerve palsy, patient not coming for followup. • Follow-up on 1st week, 1 month, 2 months. • All patients included in the study will undergo one or more BTA injections in the lacrimal gland and will be followed up for 2 months. Repeated BTA injections will be given when the patient recquire another injection for recurrent epiphora. • The severity of epiphora will be assessed with the Munk epiphora rating system and the Schirmer-1 test before injection and at 1 month and 2 months after injection. • Under topical anaesthesia with proparacaine, after elevating the lateral portion of the upper eyelid to expose the palpebral lobe of the lacrimal gland while the patient looked down and to the nasal side, a transconjunctival injection of 2.5 units/0.05 ml of BTA using a 30-gauge needle tuberculin syringe will be administered into the bulging part of the exposed palpebral lobe. RESULTS EXPECTED OUTCOME Reduction in epiphora after lacrimal gland injection of botulinum toxin will be seen in cases with functional epiphora as well as those with a physical obstruction in the lacrimal drainage pathway. CONCLUSIONS Reduction in epiphora after lacrimal gland injection of botulinum toxin will be seen in cases with functional epiphora as well as those with a physical obstruction in the lacrimal drainage pathway.