Efficacy and Safety of Botulinum Toxin Injections for Epiphora Management: A Systematic Review and Meta-Analysis
Author: Abdulrahman Alfarhan
Base Hospital / Institution: Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital
Rapid fire oral presentation
Abstract ID: 24-416
Purpose
This systematic review and meta-analysis aim to evaluate the efficacy and safety of lacrimal gland botulinum toxin injections for managing epiphora
Methods
Following the PRISMA guidelines, a comprehensive search of MEDLINE, Cochrane CENTRAL, and EMBASE databases was conducted up to February 2024. The review included studies published from 2000 to February 2024, focusing on patients treated with lacrimal gland botulinum toxin injections for epiphora, and reported relevant clinical outcomes. Data extraction covered study design, patient demographics, types of botulinum toxin used, injection techniques, dosage, follow-up duration, and outcomes such as Schirmer test scores and adverse events. Methodological quality was assessed using appropriate tools for each study type.
Results
From 517 records identified, 19 studies met the inclusion criteria, encompassing 422 patients. The meta-analysis revealed that botulinum toxin injections significantly reduced Schirmer test scores at 3 months (MD = 7.62, 95% CI 4.73 to 10.52, p < 0.0001) and at 6 months (MD = 5.33, 95% CI 2.77 to 7.90, p < 0.0001), despite the heterogeneity between studies. Adverse events were reported in 19% of patients, with ptosis (8.8%), diplopia (3.3%), and dry eye (1.4%) being the most common.
Conclusion
Lacrimal gland botulinum toxin injections are an effective and relatively safe treatment for managing epiphora, demonstrating significant improvements in tear production with manageable adverse effects. Future high-quality randomized controlled trials are needed to further confirm these findings and refine treatment protocols.
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