Crocodile Tears Syndrome

Camille ReneeDr. S., MD

Saint James School of Medicine

Symptoms Shedding tears while eating, drinking, or smelling food

Facial ‘tics’ and/or spasms

Impaired sense of taste

Salivation while crying is also evident

Pathophysiology Recovering from Bell’s Palsy - lesion of CN VII - leads

to faulty regeneration of the nerve (synkinesis)

Efferent fibres from superior salivary nucleus connected to lacrimal glands via the superior petrosal nerve, leading to improper lacrimal duct stimulation

Salivary glands may also abnormally communicate with lacrimal nucleus as well

Site of LesionFacial nerve destruction causes miswiring of nerves upon recovery in Bogorad’ssyndrome

Differential Diagnoses Nasolacrimal duct blockage

Food allergies

Conjunctivitis

Irritants

Diagnostic Tests As crocodile tear symptom is more of a symptom than

a disease, diagnosis is usually done visually without medical testing (diagnosis of exclusion)

Treatment Botulinum toxin is injected into the lacrimal gland to

inhibit nerve stimulation

A 22 year old man presents to your clinic with a one-sided facial droop, which you suspect to be hemilateral facial paralysis. After further examination you diagnose the patient with Bell's Palsy and provide him with therapeutic advice. Two weeks later, the patient returns to your office and states that he has been tearing up involuntarily while eating, a common symptom upon recovery of this disorder. You remember that this is termed 'crocodile tears syndrome' or Bogorad's Syndrome, as a colleague of yours in MD2 presented a case with the exact same symptoms. Which of the following is correct regarding crocodile tears syndrome?

a) It is usually treated with non-steroidal anti-inflammatory drugsb) It is an iatrogenic condition further exacerbated by the patient's lack of self-carec) It is caused by synkinesis of CN VIId) It is caused by synkinesis of CN IV

References1. Wikipedia. Tears. (2014). Retrieved from:

http://en.wikipedia.org/wiki/Tears#Diseases_and_disorders

2. Right Diagnosis. Lacrimation. (2014). Retrieved from: http://www.rightdiagnosis.com/sym/lacrimation.htm

3. Right Diagnosis. Bogorad’s Syndrome. (2014). http://www.rightdiagnosis.com/b/bogorads_syndrome/symptoms.htm

4. The Daily Omnivore. Diagnosis of Exclusion. (2011). Retrieved from: http://thedailyomnivore.net/2011/04/21/diagnosis-of-exclusion/

5. Montoya, F.J., Riddell, C.E., Caesar, R., & Hague, S. (2002). Treatment of gustatory hyperlacrimation (crocodile tears) with injection of botulinum toxin into the lacrimal gland. Retrieved from: http://www.nature.com/eye/journal/v16/n6/full/6700230a.html

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