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Case Reports
. 2018 May;66(5):697-699.
doi: 10.4103/ijo.IJO_904_17.

Bilateral herpes simplex keratitis reactivation after lacrimal gland botulinum toxin injection

Purvasha Narang  1 , Swati Singh  2 , Vikas Mittal  1
Affiliations
Case Reports

Bilateral herpes simplex keratitis reactivation after lacrimal gland botulinum toxin injection

Purvasha Narang et al. Indian J Ophthalmol. 2018 May.

Abstract

Botulinum toxin A (BTA) injections into lacrimal gland are being used for refractory epiphora due to intractable lacrimal disorders with success rates reported from 18% to 86%. Most common side effects are transient ptosis and diplopia. We report a case of a 59-year-old female injected with 2.5 units of BTA injection in each lacrimal gland for functional epiphora. The patient had a history of herpes simplex viral keratitis that was quiescent for more than 2 years. After 3 weeks, she developed reactivation of viral keratitis bilaterally, which was successfully managed with antivirals and topical steroids. Reactivation of quiescent herpes simplex keratitis is a possibility after lacrimal gland BTA and caution should be exercised in such cases.

Keywords: Botulinum toxin; functional epiphora; herpes simplex keratitis; lacrimal gland; reactivation.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
(a) Ptosis of right upper lid 1 week after botulinum toxin A injection into the lacrimal glands for functional epiphora. (b) Complete resolution of ptosis of right upper lid at 4 weeks
Figure 2
Figure 2
Slit-lamp photograph after reactivation of herpes simplex viral keratitis (large dendritic ulcers), 3 weeks after botulinum toxin A; (a and b) without and (c and d) with fluorescein stain in both eyes, following botulinum toxin A injection. (e and f) Slit-lamp photograph of right and left eyes showing resolution of keratitis within 4 weeks of treatment
See this image and copyright information in PMC

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