Comparison of external dacryocystorhinostomy versus injection botulinum toxin in the management of functional epiphora

Abstract

To compare the efficacy of external dacryocystorhinostomy (DCR) and botulinum toxin-A in the management of functional epiphora.A prospective, comparative, interventional study included 45 patients with functional epiphora out of which 20 patients had undergone external dacryocystorhinostomy and 25 patients received 5 units of injection botulinum toxin in the palpebral lobe of lacrimal gland as per the patient’s preference. All patients underwent syringing and fluorescein dye disappearance testing before the procedure. Epiphora was graded subjectively with Munk scores obtained before and after intervention. Duration of side effects and severity were also noted.This study showed functional epiphora common in elderly age group. Female constitued of 71.11% and male 28.89 % with female: male ratio of 2.4:1. Left eye (42.22%) predominantly involved. The overall success rate at 6 months after surgery for external DCR was 95% and that of injection botulinum was 91.17%. The overall success rate in both the group was not statistically significant(p>0.05%). Improvement in epiphora graded by Munk score was statistically significant after intervention in both the groups(p<0.05%). This study showed injection Botulinum toxin can be considered as an alternative management in case of functional epiphora for patient who do not want to undergo surgical intervention and for those with co-morbid conditions with high risk for surgical intervention like DCR.