Management of functional epiphora with botulinum toxin: a injection after lacrimal surgery

To evaluate the efficacy of botulinum toxin-A (BoNTA) injection for treating functional epiphora after lacrimal surgery.

Patients with persistent epiphora following anatomically successful 3-snip punctoplasty or external dacryocystorhinostomy (ex-DCR) received transconjunctival BoNTA injections into the lacrimal gland. Symptom severity and tear production were assessed using the Munk score, Schirmer I test, and Watery Eye Quality of Life (WeQoL) questionnaire at baseline, and at 1, 3 months, and final follow-up after injection. Outcomes were compared pre- and post-injection and between surgical subgroups.

The study included 41 eyes of 32 patients (20 ex-DCR, 21 punctoplasty). Mean follow-up was 26.06 ± 0.7 months. All outcome measures (Munk score, Schirmer I, and WeQoL) showed significant improvement after both the first and last BoNTA injections. Improvements at 1 and 3 months were similar. The ex-DCR group required fewer injections (2.75 ± 0.1 vs. 3.13 ± 0.12; p = 0.003) with longer intervals between treatments (6.1 ± 0.1 vs. 5.4 ± 2 months; p = 0.02). At the 3-month follow-up after final injections, all scores were significantly better in the ex-DCR group (p < 0.05 for most comparisons).

BoNTA injection is an effective short-term treatment for functional epiphora after lacrimal surgery, particularly with more durable results following ex-DCR compared to punctoplasty.