Transconjunctival botulinum toxin offers an effective, safe and repeatable method to treat gustatory lacrimation

Gustatory lacrimation is an aberrant re-innervation following a peripheral facial palsy, associated with uncontrollable ipsilateral tearing while eating or in anticipation of a meal.1 Fibres from the seventh cranial nerve, destined originally for the submandibular ganglion, become misdirected to the pterygopalatine ganglion. As the lacrimal glands are innervated by cholinergic fibres, gustatory lacrimation after facial palsy can be successfully treated by intraglandular injections of botulinum toxin A (BTX-A) blocking the release of acetylcholine in cholinergic nerve terminals.2 We report on the successful transconjuntival injection of BTX-A (Dysport® 10U, Ipsen Ltd, Slough, UK), with 5-year follow-up, in three patients with unilateral gustatory lacrimation following Bell's palsy. Patient 1, a 29-year-old woman, developed gustatory lacrimation 4 years after a left-sided Bell's palsy. Patient 2, a 42-year-old man, was diagnosed with gustatory lacrimation following a recovered Bell's palsy 4 years before presentation. Patient 3, …