Congenital Paradoxical Gustatory-Lacrimal Reflex and Lateral Rectus Paralysis

Increased lacrimation from any cause except pain and emotion has been termed crocodile tears. This usage has its origin in an old legend concerning crocodiles who were supposed to weep before devouring their victims. However, in the medical literature, the term crocodile tears has been almost exclusively employed to describe the copious tearing that occurs as the result of an abnormal linkage between the lacrimal and the salivary glands. This abnormal linkage has been called the paradoxical gustatory-lacrimal reflex. In this reflex the stimuli that produce salivation, i.e., gustation, chewing, and sucking, produce abnormal lacrimation in one or both eyes. This rare phenomenon may be acquired or congenital. In the acquired type it has been reported to have developed after traumatic, syphilitic, or idiopathic lesions (Bell's palsy) of the facial nerve, after section of the greater superficial petrosal nerve for headache, and after widespread disease of the brain stem,1-3