Transconjunctival versus Transcutaneous Injection of Botulinum Toxin into the Lacrimal Gland to Reduce Lacrimal Production: A Randomized Controlled Trial
The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized c...
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Published in | Toxins Vol. 13; no. 2; p. 77 |
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Abstract | The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized controlled study included 53 eyes of 31 patients with unilateral or bilateral epiphora. Patients were randomly allocated to receive an injection of BTX-A (3 units) either transconjunctivally (
= 15, 25 eyes) or transcutaneously (
= 16, 28 eyes). For objective assessments, the tear meniscus height and Schirmer's I test with topical anesthesia were measured at baseline and after 2, 6, 12, and 24 weeks of follow-up. Subjective evaluations were performed using the Munk score. After BTX-A injection, patients in both groups experienced significant objective and subjective reductions in tearing at all follow-up times compared to pre-injection (success rate 86.8%), and the effect lasted for a mean duration of 5.63 months. The two delivery routes showed similar clinical effectiveness for a single injected dose of BTX-A. In conclusion, injecting BTX-A via either a transconjunctival or transcutaneous route helps to reduce normal tear production and results in significant improvements in the symptoms in patients with epiphora. |
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AbstractList | The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized controlled study included 53 eyes of 31 patients with unilateral or bilateral epiphora. Patients were randomly allocated to receive an injection of BTX-A (3 units) either transconjunctivally (n = 15, 25 eyes) or transcutaneously (n = 16, 28 eyes). For objective assessments, the tear meniscus height and Schirmer’s I test with topical anesthesia were measured at baseline and after 2, 6, 12, and 24 weeks of follow-up. Subjective evaluations were performed using the Munk score. After BTX-A injection, patients in both groups experienced significant objective and subjective reductions in tearing at all follow-up times compared to pre-injection (success rate 86.8%), and the effect lasted for a mean duration of 5.63 months. The two delivery routes showed similar clinical effectiveness for a single injected dose of BTX-A. In conclusion, injecting BTX-A via either a transconjunctival or transcutaneous route helps to reduce normal tear production and results in significant improvements in the symptoms in patients with epiphora. The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized controlled study included 53 eyes of 31 patients with unilateral or bilateral epiphora. Patients were randomly allocated to receive an injection of BTX-A (3 units) either transconjunctivally ( = 15, 25 eyes) or transcutaneously ( = 16, 28 eyes). For objective assessments, the tear meniscus height and Schirmer's I test with topical anesthesia were measured at baseline and after 2, 6, 12, and 24 weeks of follow-up. Subjective evaluations were performed using the Munk score. After BTX-A injection, patients in both groups experienced significant objective and subjective reductions in tearing at all follow-up times compared to pre-injection (success rate 86.8%), and the effect lasted for a mean duration of 5.63 months. The two delivery routes showed similar clinical effectiveness for a single injected dose of BTX-A. In conclusion, injecting BTX-A via either a transconjunctival or transcutaneous route helps to reduce normal tear production and results in significant improvements in the symptoms in patients with epiphora. The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized controlled study included 53 eyes of 31 patients with unilateral or bilateral epiphora. Patients were randomly allocated to receive an injection of BTX-A (3 units) either transconjunctivally ( n = 15, 25 eyes) or transcutaneously ( n = 16, 28 eyes). For objective assessments, the tear meniscus height and Schirmer’s I test with topical anesthesia were measured at baseline and after 2, 6, 12, and 24 weeks of follow-up. Subjective evaluations were performed using the Munk score. After BTX-A injection, patients in both groups experienced significant objective and subjective reductions in tearing at all follow-up times compared to pre-injection (success rate 86.8%), and the effect lasted for a mean duration of 5.63 months. The two delivery routes showed similar clinical effectiveness for a single injected dose of BTX-A. In conclusion, injecting BTX-A via either a transconjunctival or transcutaneous route helps to reduce normal tear production and results in significant improvements in the symptoms in patients with epiphora. |
Author | Shin, Hyun Jin Lee, Andrew G Jang, Minsu Lee, Shin-Hyo Lee, Sang Jae |
AuthorAffiliation | 6 Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA 8 Department of Ophthalmology, University of Buffalo, Buffalo, New York, NY 14214, USA 1 Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA; AGLee@houstonmethodist.org 10 Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea; jmsmed12@naver.com 4 Department of Ophthalmology, UT MD Anderson Cancer Center, Houston, TX 77030, USA 2 Department of Ophthalmology, Neurology, Neurosurgery, Weill Cornell Medicine, New York, NY 10021, USA 7 Department of Ophthalmology, Baylor College of Medicine and the Center for Space Medicine, Houston, TX 77030, USA 3 Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA 11 School of Medicine, Konkuk University, Seoul 05029, Korea; atpsang@naver.com 5 Department of Ophthalmology, Te |
AuthorAffiliation_xml | – name: 3 Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA – name: 2 Department of Ophthalmology, Neurology, Neurosurgery, Weill Cornell Medicine, New York, NY 10021, USA – name: 7 Department of Ophthalmology, Baylor College of Medicine and the Center for Space Medicine, Houston, TX 77030, USA – name: 4 Department of Ophthalmology, UT MD Anderson Cancer Center, Houston, TX 77030, USA – name: 9 Department of Anatomy, Yonsei University College of Medicine, Seoul 03722, Korea; veterinarian2@hanmail.net – name: 6 Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA – name: 10 Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea; jmsmed12@naver.com – name: 8 Department of Ophthalmology, University of Buffalo, Buffalo, New York, NY 14214, USA – name: 5 Department of Ophthalmology, Texas A and M College of Medicine, College Station, TX 77807, USA – name: 11 School of Medicine, Konkuk University, Seoul 05029, Korea; atpsang@naver.com – name: 1 Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA; AGLee@houstonmethodist.org |
Author_xml | – sequence: 1 givenname: Andrew G surname: Lee fullname: Lee, Andrew G organization: Department of Ophthalmology, University of Buffalo, Buffalo, New York, NY 14214, USA – sequence: 2 givenname: Shin-Hyo surname: Lee fullname: Lee, Shin-Hyo organization: Department of Anatomy, Yonsei University College of Medicine, Seoul 03722, Korea – sequence: 3 givenname: Minsu surname: Jang fullname: Jang, Minsu organization: Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea – sequence: 4 givenname: Sang Jae surname: Lee fullname: Lee, Sang Jae organization: School of Medicine, Konkuk University, Seoul 05029, Korea – sequence: 5 givenname: Hyun Jin orcidid: 0000-0002-3563-8042 surname: Shin fullname: Shin, Hyun Jin organization: Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea |
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CitedBy_id | crossref_primary_10_1016_j_berh_2023_101837 crossref_primary_10_1002_ca_23870 crossref_primary_10_1089_jop_2022_0156 crossref_primary_10_1097_PRS_0000000000010802 crossref_primary_10_1016_j_mjafi_2021_09_007 crossref_primary_10_1097_IOP_0000000000002532 crossref_primary_10_4103_ijo_IJO_2909_21 crossref_primary_10_2147_IMCRJ_S379024 |
Cites_doi | 10.1097/SCS.0b013e31829ac655 10.1016/j.jfo.2017.11.010 10.1007/978-0-387-69007-0_109 10.1038/eye.2012.188 10.1097/IOP.0b013e318230b110 10.1016/j.ajo.2003.08.002 10.1016/j.bjps.2008.03.023 10.1016/j.jfo.2017.03.006 10.1136/bjo.2003.029181 10.1111/j.1755-3768.2010.01873.x 10.1136/bjo.86.7.792 10.1136/jnnp.65.1.111 10.1097/01.iop.0000244515.07925.99 10.1136/bjo.87.1.54 10.1038/eye.2015.18 10.1038/sj.eye.6700230 10.1136/bjo.2008.155887 10.1097/IOP.0b013e31826e8a86 10.1076/orbi.22.3.193.15622 10.1016/j.jaapos.2011.12.060 10.1097/IOP.0b013e318201d1d3 10.1097/00002341-200007000-00007 |
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Keywords | botulinum toxin epiphora lacrimal gland delivery route lacrimal obstruction |
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SubjectTerms | Anesthesia Botulinum toxin Botulinum toxin type A delivery route Diplopia epiphora Injection lacrimal gland Lacrimal gland and Nasolacrimal duct lacrimal obstruction Meniscus Patient satisfaction Quality of life Silicones Success Toxins |
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Title | Transconjunctival versus Transcutaneous Injection of Botulinum Toxin into the Lacrimal Gland to Reduce Lacrimal Production: A Randomized Controlled Trial |
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