Crocodile Tears Syndrome

The term “crocodile tears” stems from the ancient belief that crocodiles weep after killing their victims. Crocodile tears syndrome, also known as Bogorad syndrome, is a disorder marked by the shedding of tears while eating, chewing, smelling, or drinking in patients recovering from facial nerve (cranial nerve VII) injury. The syndrome is named after F.A. Bogorad, a Russian neuropathologist, and is also referred to as "gustatory lacrimation" or "paroxysmal lacrimation."  Crocodile tears syndrome typically occurs as a sequela of facial nerve injury, often following Bell palsy, surgery, or trauma. Aberrant regeneration of the facial nerve leads to the misdirection of its autonomic fibers toward the lacrimal glands instead of the salivary glands, resulting in lacrimal gland stimulation and tearing during mastication. The diagnosis is clinical and may be confirmed through the Schirmer test combined with gustatory stimulation. Management options include botulinum toxin injections to the lacrimal gland, topical anticholinergics, and surgical interventions such as vidian neurectomy in severe cases. The prognosis is generally favorable, but symptoms may persist, requiring periodic treatment.