Abstract
The lacrimal gland is innervated by the cholinergic fibers of the seventh cranial nerve. Injection of botulinum toxin A (BTA) in the lacrimal gland is hypothesized to decrease the tear production by blocking presynaptic release of acetylcholine into neuromuscular end plates of cholinergic nerve fibers. Therefore, injection of BTA into the lacrimal gland can be an alternative treatment for epiphora due to severe gustatory hyperlacrimation, unsalvageable proximal lacrimal drainage system obstructions, and refractory functional epiphora. This chapter will discuss BTA properties, mechanism of action, and injection techniques into the lacrimal gland and complications.
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