Crocodile Tears Syndrome (Bogorad's Syndrome) is a condition that usually occurs during recovery of Bell's palsy. Synkinesis of the facial nerve is responsible for the symptoms (crying instead of salivating, salivating while crying, etc.).

1. Crocodile Tears Syndrome
Camille Renee
Dr. S., MD
Saint James School of Medicine

2. Symptoms
 Shedding tears while eating, drinking, or smelling food
 Facial ‘tics’ and/or spasms
 Impaired sense of taste
 Salivation while crying is also evident

3. 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

4. Site of Lesion
Facial nerve
destruction causes
miswiring of
nerves upon
recovery in
Bogorad’s
syndrome

5. Differential Diagnoses
 Nasolacrimal duct blockage
 Food allergies
 Conjunctivitis
 Irritants

6. 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)

7. Treatment
 Botulinum toxin is injected into the lacrimal gland to
inhibit nerve stimulation

8. 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 drugs
b) It is an iatrogenic condition further exacerbated by the patient's
lack of self-care
c) It is caused by synkinesis of CN VII
d) It is caused by synkinesis of CN IV

9. References
1. 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
6. The Sports Physio. (2012). Prolotherapy: is it as sweet as it sounds?
http://thesportsphysio.wordpress.com/2012/11/20/prolotherapy-is-it-as-sweet-as-it-sounds/
7. Fauci, A.S., Braunwald, E., Kasper. D.L., Hauser, S.L., Longo, D.L., Jameson, J.L., Loscalzo, J.
(2009). Harrison's manual of medicine. (17th ed.). United States: McGraw-Hill Companies,
Inc.