To describe the use of botulinum toxin injection of the lacrimal gland for palliative treatment of epiphora secondary to nasolacrimal duct obstruction.

A prospective non-comparative interventional case series study was designed to include 13 patients with nasolacrimal duct obstruction. Under topical anesthesia botulinum toxin A (1-4unit) was injected into the palpebral lobe of the lacrimal gland via a transconjunctival approach. Patients underwent a Schirmer test and a subjective evaluation of their epiphora symptoms was performed at 0 (baseline), 1, 4 and 12 weeks after injection.

Subjective epiphora scores improved in 10 out of the 13 patients (76.9%). Schirmer test results showed objective reduction in tearing from baseline but did not strongly correlate with the subjective epiphora scores. Transient ptosis were experienced by two patients.

Botulinum A toxin injection for palliative treatment of epiphora secondary to nasolacrimal duct obstruction is a simple, effective and safe treatment.