A New Treatment for Epiphora Secondary to Submandibular Gland Transplantation: Transcutaneous Atropine Gel

PurposeTo explore whether topical application of atropine gel controls epiphora secondary to submandibular gland (SMG) transplantion for severe keratoconjunctivitis sicca.MethodsEighteen patients with epiphora after SMG transplantation participated in a double-blind, controlled, crossover study. Patients were treated with topical smear common atropine (CA) and modified atropine (MA) gels (intervals ≥1 day). The control effect of atropine gels was observed for 5 hours. Tear flow was quantified in resting and stimulated (after exercise) states using the Schirmer I test.ResultsWith the CA gel, tear flow decreased significantly at 10, 30, and 120 minutes. Average epiphora reduction rates (AERRs) were 22.37%, 18.14%, and 13.27%, respectively (P<.05). With the MA gel, tear flow decreased significantly from 5 minutes to 5 hours; AERRs increased from 24.06% to 42.67% (P<.05); Maximum efficacy was maintained from 15 minutes to 3 hours (P<.01); Tear flow gradually increased from 4 to 5 hours but was still lower than that before atropine use (P<.05). According to results of the Schirmer I test and AERRs, the control efficacy of the MA gel was significantly better than that of the CA gel (P<.05).ConclusionsTopical application of atropine gel could effectively control mild epiphora for patients with SMG transplantation for severe keratoconjunctivitis sicca. The efficacy of MA gel was much better than that of the CA gel.