Transconjunctival botulinum toxin injection into the lacrimal gland in crocodile tears syndrome

Purpose: To determine the efficacy and safety of botulinum toxin injection into the lacrimal gland as a symptomatic treatment of crocodile tear syndrome (CTS). Methods: Our study included six patients of unilateral gustatory hyper lacrimation following either an episode of facial paralysis or post trauma or any related surgery that posed a risk of damaging the facial nerve. Detailed history regarding previous trauma, duration of facial paralysis, previous significant surgery, and duration of steroid use following facial paralysis was noted. Schirmer抯 test was done at baseline and 3 months follow?up. Patients� consent was taken prior to treatment with botulinum toxin injection in the lacrimal gland. Repeat injection of 5 U botulinum toxin (type A) was administered into the lacrimal gland of all patients transconjunctivally within an interval of 1 week. All patients were followed up with Schirmer抯 test at 6 weeks and 3 months. Any complications during treatment were recorded. Results: All six patients showed complete or partial disappearance of reflex lacrimation while chewing following botulinum injection measured by a significant reduction in Schirmer抯 value. When comparing Schirmer test values before (27.8 � 3.58 mm) and after (11.6 � 2.28 mm) BTX?A injection, the differences observed (P = 0.002) were statistically significant (P < 0.05). Only two patients developed mild transitory ptosis. No other complications were noted. Conclusion: Transconjunctival botulinum toxin injection into the lacrimal gland is an effective and safe method to decrease reflex lacrimation during eating or chewing in CTS or gustatory hyper?lacrimation syndrome.

Homeostasis de la superficie ocular y cirugía de catarata / Ocular surface homeostasis and cataract surgery

La cirugía de catarata es la intervención oftalmológica que más se realiza a nivel mundial, fundamentalmente en personas de la tercera edad, donde coinciden cambios en la película lagrimal. Muchas veces después de operados, debido a alteraciones en la homeostasia de la superficie ocular, los pacientes mantienen síntomas muy molestos, como lagrimeo y sensación de cuerpo extraño, que les hacen dudar del buen resultado de la cirugía. Se hace una revisión del tema, para entender el porqué de esta sintomatología, sus causas y los exámenes necesarios a realizar previos a la cirugía, con el objetivo de alcanzar una mejor evolución posoperatoria. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

Cataract surgery is the most common ophthalmological procedure worldwide. It is particularly frequent in the elderly, due to the changes undergone by the tear film in advanced ages. On many occasions and due to ocular surface homeostatic alterations, patients continue to experience great discomfort after the operation, such as lacrimation or a foreign body sensation, which makes them doubt the satisfactory outcome of the surgery. A review was conducted about the topic to understand the reasons for these symptoms, their causes and the preoperative tests required to achieve a better postoperative evolution. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Olanzapine overdose presenting with pinpoint pupils and semi consciousness: a case report

Background: Olanzapine is an atypical antipsychotic widely prescribed in schizophrenia patients because of its better tolerability. Clinical picture due to olanzapine over dosage can be confusing in the emergency department. Also often the patient would be drowsy to provide adequate information regarding the method of self harm attempt. Case description: We are reporting a case of olanzapine over dosage which presented to the emergency department with pin point pupils, lacrimation, and hypotension and semi conscious state. Discussion: Organophosphorous poison consumption is one of the common methods of suicide in rural south Indian setting which presents with miosis, respiratory depression and unconsciousness. Pontine hemorrhage is one more condition apart from opiod intoxication which presents with pin point pupils and altered mental status. Conclusion: We attributed olanzapine over dosage as the cause of pin point pupils, lacrimation and drowsiness in our case as other causes were excluded.

Change of Visual Function and Lacrimation Among Male Near-Work Inspectors in a TV Manufacturing Plant / 대한산업의학회지

OBJECTIVES: The aim of this field-based longitudinal study was to investigate the effects of near-work on lacrimation and visual function, particularly refractive power. METHODS: Our study tracked sixty five male workers for about three years by means of ophthalmologic examinations and questionnaires, to collect data including eye symptoms and subjective work environmental factors. Ophthalmic examinations included visual acuity, Shirmer I test, and autorefractometry. In the first year, the inclusion criteria were ages less than 40 years, no history of ophthalmic diseases, emmetropia(-1.0

Schrimer test in Parkinson's disease

We carried out the Schirmer test to measure objectively the amount of lacrimation among 51 clinically diagnosed parkinsonian patients (33 men and 18 women aged 50 to 79 years, mean 64) and 75 age-matched controls (42 men and 33 women aged 50 to 76, mean 62). Whatman No. 2 paper, prepared in precut strips 5mm by 35mm, was placed in the cul-de-sac for five minutes, after which the wetted length of the strip was studied. It was noted that the lacrimation amount decreased in patients with Parkinson's disease compared with controls: the average amount of lacrimation was 3.4 +/- 2.3mm in the former group and 8.1 +/- 6.5mm in the latter group (p < 0.01). We believe that the decrease in the amount of lacrimation is associated with emotional disturbance and autonomic dysfunction, and presume that the lacrimation may be under the control of the basal ganglia which has a connection with the superior salivatory nucleus downward and the limbic system upward.

Factors Influencing Corneal Involvement in Leprosy

Recently, in leprosy patients the frequency of the blindness due to corneal disorder has been increased. We evaluated factors influencing corneal involvement in leprosy patients for the purpose of early detection and treatment of the preventable causes of the blindness. In 100 eyes of 100 leprosy patients and 50 eyes of 50 control who had no abnormality in ocular examination. Each patient was examined with corneal sensitivity test, Schirmer test(Type I) and was graded according to severity of lagophthalmos. The results were as follows: 1. 28 eyes(28%) of the leprosy patients and 3 eyes(3%) of the control patients showed less than 5mm wetting of fiter paper respectively. 2. Corneal sensation was decreased moderately or markedly in 42 eyes(42%) of the leprosy patients and 7 eyes(14%) of the control patients respectively. 3. The values of Schirmer test and corneal sensation were decreased with increasing duration of the disease. 4. In leprosy patients, 32 patients(32%) were showed lagophthalmos. The grade of lagophthalmos was increased with increasmg duration of the disease. These results suggest that leprosy patients should be followed closely for factors(corneal sensation, decreased lacrimation, lagophthalmos) affecting cornea and that treatment directed towards this problem should be initiated early.