September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Determination of the optimum delivery route for the intraglandular administration of botulinum toxin A in patients with refractory epiphora
Author Affiliations & Notes
  • Christina Y. Weng
    Ophthalmology, Baylor College of Medicine-Cullen Eye Institute, Houston, Texas, United States
  • Elizabeth Houle
    Ophthalmology, University of Vermont, Burlington, Vermont, United States
  • Kathleen C Oktavec
    Ophthalmology, Columbia University, New York, New York, United States
  • Jing Tian
    Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
  • Shannath L Merbs
    Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Christina Weng, None; Elizabeth Houle, None; Kathleen Oktavec, None; Jing Tian, None; Shannath Merbs, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4032. doi:
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      Christina Y. Weng, Elizabeth Houle, Kathleen C Oktavec, Jing Tian, Shannath L Merbs; Determination of the optimum delivery route for the intraglandular administration of botulinum toxin A in patients with refractory epiphora. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4032.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The purpose of this study is to compare the effect of botulinum toxin A injected transconjunctivally into the palpebral lobe of the lacrimal gland to the effect of the same dose injected transcutaneously into the orbital lobe in patients with epiphora because of anatomical or functional outflow obstruction.

Methods : Randomized, prospective, blinded, interventional trial which included patients with unilateral or bilateral epiphora due to either anatomic outflow obstruction or functional etiology. Patients were randomized to botulinum toxin A (5 units) injection either transconjunctivally into the palpebral lobe or transcutaneously into the orbital lobe. To objectively measure tear production, patients underwent a Schirmer’s test (at baseline, week 1, week 4 <for those with adverse effects> and week 12). To subjectively measure epiphora, patients provided self-evaluation of their tearing symptoms (at baseline, week 1, week 4, week 12, and week 24). Main outcome measures were tear production via Schirmer’s test with and without anesthesia; epiphora severity self-reported by the patient; adverse effects following injection.

Results : Patients in both groups experienced both a subjective and objective reduction in tearing at all study visits compared to pre-injection. Patients injected transconjunctivally in the palpebral lobe had a greater objective reduction in tear production at the 4-week visit compared with patients injected transcutaneously in the orbital lobe (p = 0.03). Additionally, patients who underwent transconjunctival injection into the palpebral lobe experienced significantly fewer side effects at 1 week than patients with injection into the orbital lobe (p = 0.03).

Conclusions : Transconjunctival injection of botulinum toxin A into the palpebral lobe of the lacrimal gland is both more effective in the treatment of epiphora from anatomical or functional outflow obstruction, and results in fewer side effects than transcutaneous injection into the orbital lobe of the lacrimal gland.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Figure 1. Mean epiphora severity scores at baseline and post-injection time points

Figure 1. Mean epiphora severity scores at baseline and post-injection time points

 

Figure 2. Mean Schirmer’s with anesthesia measurements at baseline and post-injection time points

Figure 2. Mean Schirmer’s with anesthesia measurements at baseline and post-injection time points

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