Crocodile tears syndrome after vestibular schwannoma surgery: A case report

Crocodile tears syndrome is paroxysmal lacrimal hypersecretion while eating or drinking. It is relatively rare and mainly observed after peripheral facial nerve injury due to any cause.

We describe a case of crocodile tears syndrome after vestibular schwannoma surgery in a patient with pre-operative trigeminal nerve involvement. We also discuss the various treatment options offered to the patient and the natural course of the illness.

It is hypothesized that facial nerve fibers undergo misdirected re-innervation of the lacrimal gland instead of the salivary gland. After vestibular schwannoma surgery, facial nerve palsy is well described. The sensory symptoms are relatively neglected by the surgeon, even though they cause discomfort to the patient. This may be the cause for the underestimation of its incidence.

The knowledge of the incidence, mechanism and natural course of crocodile tears syndrome along with patient education is important to reduce post-operative distress to the patient. We also hypothesize the correlation of crocodile tears syndrome with motor component of facial function and the role of preservation of nervus intermedius in reducing post-operative facial palsy.