Bogorad syndrome is a rare complication of (traumatic) facial paralysis with inappropriate and sometimes profuse tearing (hyperlacrimation) during eating. That is why this syndrome is better known as the “crocodile tears syndrome” or “gustatolacrimal reflex”. Crocodile tears are caused by nerve fibers in the salivary gland being damaged after facial paralysis and accidentally growing again in a tear gland. The Russian neuropathologist Bogorad first described this syndrome in 1913.
- Epidemiology Bogorad syndrome
- Causes and heredity of the condition
- Symptoms: Crocodile tears when eating or drinking
- Treatment of crocodile tear syndrome via Botox injection
- Disease prognosis
Epidemiology Bogorad syndrome
Crocodile tear syndrome occurs in 3.3 to 6.5% of patients after Bell’s palsy (sudden facial paralysis due to nerve damage). The syndrome also presents itself after maxillary trauma, leprosy, Paget’s disease (chronic inflammation of the bone) and other infectious and vascular diseases. The scientific literature reports about 95 cases.
Causes and heredity of the condition
The condition occurs spontaneously or is acquired.
Sometimes the syndrome occurs spontaneously at birth. However, no scientifically based information is known regarding heredity.
Bell’s palsy is a traumatic form of facial paralysis. As a result, one half of the face suddenly stops responding. This is a frightening sight, but 85% of patients recover within three weeks, even without treatment. During this recovery, 3 to 6% of patients develop the acquired form of crocodile tear syndrome.
Symptoms: Crocodile tears when eating or drinking
When the patient begins to eat or drink, he begins to cry spontaneously, unlitarally (medical term for “one-sided”), profusely and uncontrollably without making any sound; he is crying “crocodile tears”, so to speak. This is the result of a neurological mix-up. The lacrimal glands begin to work instead of the salivary glands. Loss of taste and a facial tic are also possible. The severity and duration of tearing varies from patient to patient. A pediatrician notices this in the hospital because a baby cries but makes no sound when eating and tends to appear tense. The symptoms stop when the patient stops eating or drinking. Furthermore, the symptoms also occur with any type of food or drink.
Thanks to an injection, it is no problem to use (eye) cosmetics / Source: Manuel Marín, Wikimedia Commons (CC BY-2.0)
Treatment of crocodile tear syndrome via Botox injection
There is no effective treatment for crocodile tear syndrome, but usually a botulinum toxin injection (Botox injection) into the lacrimal gland using an EMG (electromyography) is a good treatment option. This blocks signals to the nerves, causing involuntary tears to no longer occur. In a clinical study, all patients reported partial or complete resolution of excessive tearing after treatment. The treatment usually works after 24-48 hours after the first injection and results last for 4-5 weeks. This makes treatment with botulinum toxin simple, safe and effective. Thanks to an injection, a patient also wears makeup and eye cosmetics perfectly. Without an injection, the make-up always runs off when the patient starts eating or drinking.
Disease prognosis
No information is available about the prognosis of this condition. This is usually a very frustrating disease for the patient. He seems unhappy or emotionally unstable, but he is not. However, the environment does not always understand this properly, which sometimes causes the patient to isolate himself. Going out to eat is very difficult for the patient. That is why the environment best supports the patient on an emotional and practical level, for example by offering a handkerchief while eating/drinking.
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