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Botulinum toxin injection and tear production

Alsuhaibani, Adel H.a; Eid, Shaikha Alb

Current Opinion in Ophthalmology: September 2018 - Volume 29 - Issue 5 - p 428–433
doi: 10.1097/ICU.0000000000000506

Purpose of review In 1980, botulinum toxin type A (BTX-A) was introduced for the treatment of strabismus and benign essential blepharospasm. Since then, a number of additional indications have been introduced, which continue to expand, providing less invasive solutions in managing different ophthalmic conditions.

Recent findings Successful trials of BTX-A injection into the lacrimal gland have been reported for the treatment of epiphora caused by primary lacrimal gland hyperlacrimation, functional tearing, gustatory tearing, and lacrimal outflow obstruction. This is achieved through blockage of the cholinergic receptors by BTX-A at the glandular level. Interestingly, BTX-A has also been found to be useful in treating patients with dry eyes by compromising the tear drainage from the eye through injection of BTX-A in the medial part of the lower eyelid. BTX-A may help provide effective relief for patients who have two different ophthalmic comorbidities such as benign essential blepharospasm and dry eye.

Summary Better understanding of the mechanism of BTX-A action in the treatment of the growing applications in ophthalmology helps provide relatively noninvasive solutions for patients. Full awareness of possible side effects of BTX-A and the optimal way to manage them is vital for the success of this treatment option.

aDepartment of Ophthalmology, College of Medicine, King Abdulaziz University Hospital, King Saud University

bDepartment of Ophthalmology, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia

Correspondence to Adel H. Alsuhaibani, MD, Department of Ophthalmology, College of Medicine, King Abdulaziz University Hospital, King Saud University, PO Box 245, Riyadh 11411, Kingdom of Saudi Arabia. Tel: +966 11 282 3350; fax: +966 11 477 5724; e-mail:

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