Wabbels B, Förl M
Universitätsaugenklinik Bonn, Ernst-Abbe-Strasse 2, 53127 Bonn.
Ophthalmologe. 2007 Sep;104(9):771-6. doi: 10.1007/s00347-007-1592-z.
After proximal facial nerve lesions, misrouting of nerve fibres may cause the phenomenon of crocodile tears. Transconjunctival injections of botulinum toxin in the palpebral part of the lacrimal gland are the treatment of choice. An initial dose of 2.5 U of toxin is recommended, and injections may be repeated after 6 months if symptoms reoccur. Botulinum toxin A is also a highly effective temporary treatment for involutional (spasmodic) entropion until surgery is performed. A dose of 10 U of botulinum toxin is injected in the pretarsal part of the lower lid near the eyelashes. Botulinum toxin treatment is also effective for dysthyroid upper eye lid retraction, especially in instable thyroid disease or mild retraction. Slight transient ptosis may occur in some cases. Depending on the amount of retraction, a dose of 5 or 7.5 U of toxin is injected into the subconjunctival space at the superior margin of the tarsal plate.
面神经近端损伤后，神经纤维错向走行可导致鳄鱼泪现象。经结膜向泪腺睑部注射肉毒杆菌毒素是首选治疗方法。建议初始毒素剂量为2.5 U，若症状复发，6个月后可重复注射。在进行手术前，肉毒杆菌毒素A也是治疗退行性（痉挛性）睑内翻的一种高效临时治疗方法。在下睑靠近睫毛的睑板前部分注射10 U肉毒杆菌毒素。肉毒杆菌毒素治疗对甲状腺功能异常导致的上睑退缩也有效，尤其是在甲状腺疾病不稳定或轻度退缩的情况下。某些病例可能会出现轻微短暂性上睑下垂。根据退缩程度，在睑板上缘的结膜下间隙注射5或7.5 U毒素。
