Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial | Archivos de la Sociedad Española de Oftalmología (English Edition)

 array:24 [
  "pii" => "S2173579422001116"
  "issn" => "21735794"
  "doi" => "10.1016/j.oftale.2022.06.011"
  "estado" => "S300"
  "fechaPublicacion" => "2022-10-01"
  "aid" => "2023"
  "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Arch Soc Esp Oftalmol. 2022;97:549-57"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0365669122001253"
      "issn" => "03656691"
      "doi" => "10.1016/j.oftal.2022.03.010"
      "estado" => "S300"
      "fechaPublicacion" => "2022-10-01"
      "aid" => "2023"
      "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Arch Soc Esp Oftalmol. 2022;97:549-57"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo original</span>"
        "titulo" => "Tratamiento de la ep&#237;fora funcional con toxina botul&#237;nica tipo A frente a la tira tarsal en un ensayo aleatorizado"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "549"
            "paginaFinal" => "557"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1166
                "Ancho" => 2341
                "Tamanyo" => 137953
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de las escalas de Munk&#46; Grupo de toxina botul&#237;nica A &#40;TBA&#41;&#58; la puntuaci&#243;n media de Munk disminuy&#243; significativamente en todo el per&#237;odo de seguimiento &#40;todas las semanas p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Grupo de la tira tarsal lateral &#40;TTL&#41;&#58; la puntuaci&#243;n media de Munk disminuy&#243; significativamente en todo el per&#237;odo de seguimiento &#40;semanas 2 y 6&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#59; semana 12&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0003&#59; semana 18&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; semana 24&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#59; semana 30&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#41;&#46; Diferencias significativas entre grupos en la semana 6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0152&#41; y en la semana 12 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0267&#41;&#46; Los valores p se calcularon mediante modelos lineales mixtos&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "B&#46; Maroto Rodr&#237;guez, B&#46; T&#46;L&#46; Stoica, N&#46; Toledano Fern&#225;ndez, I&#46; Genol Saavedra"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Maroto Rodr&#237;guez"
              ]
              1 => array:2 [
                "nombre" => "B&#46; T&#46;L&#46;"
                "apellidos" => "Stoica"
              ]
              2 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Toledano Fern&#225;ndez"
              ]
              3 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Genol Saavedra"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173579422001116"
          "doi" => "10.1016/j.oftale.2022.06.011"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422001116?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669122001253?idApp=UINPBA00004N"
      "url" => "/03656691/0000009700000010/v1_202209300802/S0365669122001253/v1_202209300802/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173579422001086"
    "issn" => "21735794"
    "doi" => "10.1016/j.oftale.2022.06.009"
    "estado" => "S300"
    "fechaPublicacion" => "2022-10-01"
    "aid" => "2015"
    "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Soc Esp Oftalmol. 2022;97:558-64"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Surgical outcomes of acquired acute comitant esotropia&#46; Causes and classification"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "558"
          "paginaFinal" => "564"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Resultados quir&#250;rgicos de la esotrop&#237;a adquirida comitante aguda&#46; Causas y clasificaci&#243;n"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Merino, M&#46; Freire, J&#46; Y&#225;&#241;ez-Merino, P&#46; G&#243;mez de Lia&#241;o"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Merino"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Freire"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Y&#225;&#241;ez-Merino"
            ]
            3 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "G&#243;mez de Lia&#241;o"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0365669122001162"
        "doi" => "10.1016/j.oftal.2022.03.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669122001162?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422001086?idApp=UINPBA00004N"
    "url" => "/21735794/0000009700000010/v1_202209300752/S2173579422001086/v1_202209300752/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173579422001220"
    "issn" => "21735794"
    "doi" => "10.1016/j.oftale.2022.07.002"
    "estado" => "S300"
    "fechaPublicacion" => "2022-10-01"
    "aid" => "2030"
    "copyright" => "Sociedad Espa&#241;ola de Oftalmolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Soc Esp Oftalmol. 2022;97:543-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Telemedicine in retinopathy of prematurity&#58; Crossing borders in pediatric vision health&#46; TELEROP study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "543"
          "paginaFinal" => "548"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Telemedicina en retinopat&#237;a del prematuro&#58; Atravesando fronteras en la salud visual pedi&#225;trica&#46; Estudio TELEROP"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 604
              "Ancho" => 805
              "Tamanyo" => 52988
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Fig&#46; "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">RetCam Image&#46; Retinopathy of prematurity Stage 2 Zone 2&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;A&#46; Sosa Lockward, N&#46; Abreu Arbaje, M&#46; Garc&#237;a M&#233;ndez, A&#46; Juan, J&#46;A&#46; Sosa Pe&#241;a, J&#46;F&#46; Batlle Pichardo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Sosa Lockward"
            ]
            1 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Abreu Arbaje"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Garc&#237;a M&#233;ndez"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Juan"
            ]
            4 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Sosa Pe&#241;a"
            ]
            5 => array:2 [
              "nombre" => "J&#46;F&#46;"
              "apellidos" => "Batlle Pichardo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0365669122001575"
        "doi" => "10.1016/j.oftal.2022.05.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669122001575?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422001220?idApp=UINPBA00004N"
    "url" => "/21735794/0000009700000010/v1_202209300752/S2173579422001220/v1_202209300752/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Treatment for functional epiphora with botulinum toxin-A versus lateral tarsal strip in a randomized trial"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "549"
        "paginaFinal" => "557"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "B&#46; Maroto Rodr&#237;guez, B&#46;T&#46;L&#46; Stoica, N&#46; Toledano Fern&#225;ndez, I&#46; Genol Saavedra"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "B&#46;"
            "apellidos" => "Maroto Rodr&#237;guez"
            "email" => array:2 [
              0 => "bormar77@yahoo.es"
              1 => "Borja.maroto@salud.madrid.org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "B&#46;T&#46;L&#46;"
            "apellidos" => "Stoica"
          ]
          2 => array:2 [
            "nombre" => "N&#46;"
            "apellidos" => "Toledano Fern&#225;ndez"
          ]
          3 => array:2 [
            "nombre" => "I&#46;"
            "apellidos" => "Genol Saavedra"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Oftalmolog&#237;a&#44; Hospital Universitario de Fuenlabrada&#44; Fuenlabrada&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento de la ep&#237;fora funcional con toxina botul&#237;nica tipo A frente a la tira tarsal en un ensayo aleatorizado"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2149
            "Ancho" => 2508
            "Tamanyo" => 420677
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Disposition of patients showing randomization&#44; number of patients completing or withdrawing from the trial and follow-up&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The term &#8216;functional epiphora&#8217; is used to encompass the concept of lacrimal drainage dysfunction in the presence of anatomical patency&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It can affect the quality of life of patients due to ocular irritation&#44; blurry vision that sometimes may have implications in their social lives&#46; The mechanism for tear drainage is not fully understood&#46; It can be explained by the theory of the lacrimal pump and its failure could cause the functional epiphora&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Controversies exist among ophthalmologists in the evaluation and management of the functional epiphora&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> In a survey among members of the American Society of Ophthalmic Plastic and Reconstructive Surgery &#40;ASOPRS&#41;&#44; 41&#37; of responders would perform a Dacryocystorhinostomy &#40;DCR&#41; for these patients&#44; while 25&#37; would use either silicone intubation&#44; lid tightening or a combination of both&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Outcomes of this study showed that horizontal lid tightening is a safe and effective surgical method that improves signs of functional epiphora&#46; The horizontal lid tightening of the lower eyelid&#44; with lateral tarsal strip &#40;LTS&#41;&#44; aims to improve the lacrimal pump&#46; Thus&#44; it offers an improvement of epiphora in those patients with certain eyelid laxity&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The surgical intervention for horizontal tightening with LTS is safer&#44; less invasive&#44; time-saving and has less complications than DCR&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Botulinum toxin-A &#40;BoNTA&#41; is a neurotoxin produced by <span class="elsevierStyleItalic">Clostridium botulinum</span> which causes a reversible blockage of acetylcholine release from cholinergic nerve fibers&#46; Therapeutic benefits of BoNTA have been reported for strabismus&#44; dystonia&#44; torticollis and blepharospasm due to decreased muscle hyperfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has also been used for the control of hypersecretion of glands with cholinergic innervation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Injection of BoNTA into the lacrimal gland decreases tear production by blocking presynaptic release of acetylcholine&#44; as shown in the study by Demetriades performed on rabbit eyes&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this clinical trial&#44; we compared the efficacy of BoNTA &#40;Xeomin&#174;&#44; Merz&#41; injection into the lacrimal gland versus the surgical horizontal lid tightening &#40;using LTS&#41; for the treatment of functional epiphora&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This is a randomized clinical trial with sequential&#44; parallel&#44; non-blind though observer blinded study design performed in the Ophthalmology Department of the Fuenlabrada University Hospital &#40;Madrid&#41; from September 9st&#44; 2017 through May 31st&#44; 2019&#46; Patients aged 18 years or older with unilateral or bilateral functional epiphora were included&#46; The inclusion and exclusion criteria are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; After explaining the protocol of the clinical trial&#44; each patient singned the Informed Consent before starting the study and were assigned to one of the treatment arms&#58; BoNTA or surgery with LTS&#44; following a computer-generated randomization list according to a 1&#58;1 scheme&#46; Randomization was independently conducted via an online web-based application&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the tenets of Declaration of the Helsinki and following the legal regulation on clinical trials in Spain&#46; Ethics approval was obtained from the Fuenlabrada University Hospital &#40;Madrid&#41; Institutional Review Board and the study was registered with the clinical trial registration number EudraCT 2016-000740-34&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Procedure and follow-up</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Technique for injection of BoNTA</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients assigned to BoNTA treatment group received a transconjunctival injection of BoNTA &#40;XEOMIN&#174;&#44; Merz&#41; into the lacrimal gland&#46; The BoNTA was reconstituted with sterile saline solution at a concentration of 50 U in 0&#46;5&#8239;mL&#46; Injections were always performed by the same physician&#46; The treatment with BoNTA was not repeated in any patients during our study&#46; Before injection&#44; all patients received topical anesthetic drops &#40;0&#46;5&#37; proparacaine hydrochloride&#41;&#46; The lateral upper eyelid was manually everted&#44; while the patient looked down and to the opposite side of the lacrimal gland being injected&#46; This allowed a good view of the palpebral lobe of the lacrimal gland&#46; A transconjunctival injection of 0&#46;05&#8239;mL of the reconstituted solution &#40;BoNTA 5 U&#41; was given into the palpebral lobe of the lacrimal gland of the affected eye&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical technique for LTS</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients designated to LTS surgery were operated by the same surgeon&#46; A mixture of lidocaine 2&#37; with bupivacaine 0&#46;5&#37; and 1&#58;100&#44;000 epinephrine for hemostasis was injected into the inferior lid and lateral canthal area&#46; A lateral canthotomy is performed to horizontally divide the lateral canthal tendon&#46; The inferior crus of the canthal tendon is cut to complete the cantholysis&#46; Next&#44; the anterior and posterior lamella of the eyelid were separated at the gray line and the pilosebaceous units were excised to expose the underlying tarsus&#46; The lower eyelid retractors and conjunctiva were cut at the inferior border of the tarsal plate&#46; The resulting strip was slightly shorted and then sutured to the periosteum on the inside of the lateral orbital rim with a double-armed 5-0 Prolene suture&#46; The suture was tied with mild tension&#46; Next&#44; the lateral canthal angle was reformed using a 6&#8211;0 Vicryl suture&#46; Lastly&#44; the skin was sutured with 6&#8211;0 Silk suture&#46; Postoperatively topical antibiotic ointment was prescribed 3 times a day for 1 week&#46; Skin sutures were removed after 1 week&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At first visit demographic information &#40;age&#44; gender&#41; and affected eye with epiphora were collected&#46; Best corrected visual acuity &#40;BCVA&#41; measured with decimal scale&#44; the amount of eyelid hyperlaxity in terms of eyelid distraction &#40;distance in mm from the free margin of the lower eyelid to the limbus measured for the lower eyelid&#41; were examined&#46; Objective evaluation was carried out with Schirmer test with anesthetic drops &#40;0&#46;5&#37; proparacaine hydrochloride&#41;&#46; Briefly&#44; a Schirmer strip was placed on the lower conjunctival sac between the lateral area and the external third of the sac for 5&#8239;min to measure the production of tears in millimeters&#46; Subjective evaluation of epiphora was graded using the Munk scale according to the number of times a day the patient reported dabbing away tears&#58; 0&#8239;&#61;&#8239;no epiphora&#59; 1&#8239;&#61;&#8239;occasional epiphora requiring dabbing less than twice a day&#59; 2&#8239;&#61;&#8239;epiphora requiring dabbing 2&#8211;4 times a day&#59; 3&#8239;&#61;&#8239;epiphora requiring dabbing 5&#8211;10 times a day&#59; 4&#8239;&#61;&#8239;epiphora requiring dabbing more than 10 times a day&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">For the assessment of the quality of life a questionnaire designed by Shin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> was used&#46; It consists in the self-evaluation of visual symptoms caused by epiphora that affect daily activities based on the Ocular Surface Diseased Index &#40;OSDI&#41;&#46; Patients have to grade the disturbances caused by the epiphora in 10 daily life activities &#40;reading&#44; driving at day&#44; driving at night&#44; working with a computer&#44; watching TV&#44; working related activities&#44; home related activities&#44; outdoor activities&#44; interpersonal relationships and happiness in general&#41; assessed on a scale from 0 to 4 &#40;0&#8239;&#61;&#8239;never causes discomfort&#44; 1&#8239;&#61;&#8239;Sometimes&#44; 2&#8239;&#61;&#8239;Often&#44; 3&#8239;&#61;&#8239;Almost always&#44; 4&#8239;&#61;&#8239;Always&#41;&#46; The mean score was calculated excluding items that the patient had not answered&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Follow-up visits were performed at 2&#44; 6&#44; 12&#44; 18&#44; 24 and 30 weeks and the following items were evaluated at each visit&#58; Munk scale&#44; Schirmer test&#44; quality of life questionnaire&#44; and a global subjective qualitative evaluation of the improvement of the epiphora by selecting one option to the question of how they were feeling about lacrimation&#58; A&#8239;&#61;&#8239;completely better&#59; B&#8239;&#61;&#8239;a lot better but not completely&#59; C&#8239;&#61;&#8239;a little better&#59; D&#8239;&#61;&#8239;no better&#44; no worse&#44; equal&#59; E&#8239;&#61;&#8239;worse&#46; Answer A&#44; B or C were interpreted as improvement of the epiphora&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All questionnaires and the data were completed by an independent physician blinded to cohort allocation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The adverse events &#40;AE&#41; were collected in both groups&#46; The causal relationship between an AE and either the botulinum toxin or the LTS technique was graded by the investigator as&#58; no relationship&#44; unlikely&#44; possible&#44; probable&#44; definitive or not assessable&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study endpoints</span><p id="par0070" class="elsevierStylePara elsevierViewall">The main objective of the study was to evaluate the improvement of epiphora assessed by Munk scale&#44; Schirmer test and quality of life at 6 weeks of treatment versus baseline&#46; Secondary objectives were the changes on these scales during the study follow up period &#40;after 2&#44;12&#44;18&#44;24 and 30 weeks&#41;&#46; Likewise&#44; the subjective epiphora improvement was assessed by the patient at each visit with the global subjective qualitative evaluation as well as the duration of effectiveness of BoNTA and LTS treatments&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The maximum follow-up period for each patient was 30 weeks including several visits&#44; even though the patient participation in the trial ended when the epiphora recurred i&#46;e&#46; when there was no effect of either BoNTA or LTS &#40;answer D or E in the global subjective qualitative evaluation&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sample size calculation and statistica analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Sample size was determined according to the main objective&#46; Assuming that in the population with functional epiphora Munk scale scores can range from 3&#8239;&#177;&#8239;1&#46;5&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> 12 patients per group are required to detect a difference of at least 2 points between treatments using a bilateral comparison &#40;Student <span class="elsevierStyleItalic">t</span>-test for independent samples&#41; with an &#945; error of 0&#46;05&#44; a &#946; error of 0&#46;2 and an estimation of 15&#37; losses to follow-up&#46; Thus&#44; a total sample size of 24 patients is needed for the trial&#44; 12 patients assigned to each treatment group&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Descriptive analysis was used to present the demographic and clinical characteristics of the two treatment groups&#46; Quantitative variables were expressed as mean&#8239;&#177;&#8239;Standard Deviation &#40;SD&#41;&#44; minimum&#44; maximum &#40;range&#41; and 95&#37; confidence Interval &#40;CI&#41;&#46; Qualitative variables were expressed as absolute and relative frequencies&#46; Paired <span class="elsevierStyleItalic">t</span>-test or Wilcoxon for intragroup and independent <span class="elsevierStyleItalic">t</span>-test or U Mann-Whitney between groups were used for continuous variables&#59; whereas Chi-square or Fisher test were used for qualitative variables&#46; In case of non-independent observations&#44; lineal mixed models &#40;continuous variables&#41; or logistic mixed models &#40;categorical variables&#41; were performed&#46; An electronic database was created for the study&#46; Prognostic factors and risk profiles were calculated with a logistic regression model and the median failure time with the survival analysis using the Kaplan Meier method&#46; The reliability and accuracy of the analysis were always guaranteed&#46; The level of significance used in all the statistical tests performed with the results was 0&#44;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Thirty patients were included in the randomized clinical trial from November 2017 to July 2018&#46; Fifteen patients were randomly assigned to BoNTA group and 15 to LTS group&#46; After randomization&#44; 5 patients withdrew their previous consent and decided to exit the clinical trial&#46; Finally&#44; the analysis population consisted of 25 patients&#44; 12 patients &#40;21 eyes&#41; were treated with BoNTA and 13 patients &#40;20 eyes&#41; with a LTS&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; There was only one patient lost to follow up in the BoNTA group at week 30&#46; It was the patient&#8217;s own decision&#44; not due to medical reasons&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Mean age was 61&#46;9 &#40;range 35&#8211;75&#41; years and the distribution males&#47;females was 12&#47;88&#37;&#46; Epiphora was bilateral in 64&#37; of the patients&#46; The baseline characteristics of the two study groups were well balanced &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the main objective&#44; Munk scale scores significantly decreased from baseline in both treatment groups during the entire follow-up period &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">After 6 weeks of treatment there was a decrease in Munk scores from 3&#46;9 to 1&#46;43 in patients treated with BoNTA&#44; and from 3&#46;9 to 2&#46;35 in patients treated with LTS&#46; This reduction was significantly greater in BoNTA group compared with LTS &#40;BoNTA&#58; &#8722;2&#46;48 CI 95&#37; &#91;&#8722;3&#46;0&#44; &#8722;1&#46;9&#93; vs LTS&#58; &#8722;1&#46;55 CI 95&#37; &#91;&#8722;2&#46;2&#44; &#8722;0&#46;9&#93;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;015&#41;&#46; Moreover&#44; it was also maintained after 12 weeks of treatment&#44; with a decrease in Munk scores from 3&#46;9 to 1&#46;21 &#40;TBA&#58; &#8722;2&#46;68 CI 95&#37; &#91;&#8722;3&#46;3&#44; &#8722;2&#46;0&#93; vs LTS&#58; &#8722;1&#46;69 CI 95&#37; &#91;&#8722;2&#46;5&#44; &#8722;0&#46;9&#93;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;027&#41;&#46; However&#44; no differences were observed in epiphora grading during the follow-up period between both treatments&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In the group treated with BoNTA there was a decrease in the Schirmer test being statistically significant at week 2 &#40;&#8722;3&#46;29&#8239;mm&#59; CI 95&#37; &#8722;6&#46;5&#44; &#8722;0&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05&#41;&#44; at week 12 &#40;&#8722;4&#46;95&#8239;mm&#59; CI 95&#37; &#8722;8&#46;9&#44; &#8722;0&#46;9&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05&#41; and at week 30 &#40;&#8722;5&#46;57&#59; CI 95&#37; &#8722;9&#46;4&#44; &#8722;1&#46;7&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; As expected&#44; no significant changes versus baseline in the Schirmer test were observed in the patients treated with LTS&#46; However&#44; there were no significant differences versus baseline between both treatment groups&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Quality of life of patients significantly improved compared to baseline in both treatment groups during the entire follow-up period&#44; without significant differences between groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">At 6 weeks follow-up 90&#46;5&#37; of patients treated with BoNTA and 84&#46;2&#37; of LTS group had an improvement in their epiphora according to the global subjective qualitative evaluation without significant differences between both groups&#46; At week 30 66&#46;7&#37; of patients treated with BoNTA and 65&#37; of patients from LTS group showed improvement &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The median duration of the treatment effect with BoNTA was 26&#46;2 &#40;range 7&#46;7&#8211;36&#46;6&#41; weeks and 24&#46;8 &#40;6&#46;7&#8211;37&#46;6&#41; weeks with LTS&#44; without statistically significant difference &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;9368&#41; between the two groups &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">There were 9 patients &#40;36&#37;&#41; with AE&#58; 5 patients treated with BoNTA &#40;41&#46;7&#37;&#41; and 4 patients treated with LTS &#40;30&#46;8&#37;&#41;&#46; The AE in BoNTA-treated patients were&#58; 3 eyelid ptosis&#44; 1 metamorphopsia and 1 conjunctivitis&#46; In LTS patients AE recorded were&#58; 3 surgical scar discomfort and 1 conjunctivitis&#46; All eyelid ptosis in BoNTA group &#40;25&#37;&#44; 3&#47;12&#41; were considered to be related to the study medication&#44; they resolved by 28&#44; 30 and 34 weeks respectively&#44; the other two AE were not considered related to the administration of BoNTA&#46; The 3 surgical scar discomfort in the LTS group were considered related to the intervention &#40;23&#37;&#44; 3&#47;13&#41;&#46; There were no significant differences in AE between the 2 groups&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;722&#46; Regarding AE intensity&#44; no AE was considered serious&#46; Three AE in the BoNTA group were classified as moderate intensity and the remaining six AE in the trial of mild intensity &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">To our knowledge this is the first study to compare the efficacy of BoNTA versus LTS in functional epiphora&#46; The major finding of this randomized clinical trial is that BoNTA injections into the lacrimal gland can improve functional epiphora with the same effect as a LTS&#44; and without permanent complications&#46; Moreover&#44; in terms of decrease of Munk scores&#44; our results provide evidence of greater effectiveness of BoNTA &#40;Xeomin&#174;&#41; for functional epiphora at 6 weeks &#40;from 3&#46;9 to 1&#46;43&#41; and 12 weeks &#40;from 3&#46;9 to 1&#46;21&#41; after injection compared with LTS&#46; Similar decreases on the Munk scale are observed in other series&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14</span></a> However&#44; there were no no differences in epiphora grading between the two groups at next follow-up visits&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Compared to pre-injection values&#44; the decrease in the Schirmer test results was statistically significant after treatment with BoNTA at the 2&#44; 12 and 30 weeks visit from 15&#46;24&#8239;mm to 11&#46;95&#44; 9&#46;53 and 7&#46;79&#8239;mm respectively&#46; As expected&#44; there was no significant change for this parameter in the group of patients undergoing LTS versus baseline&#46; Also&#44; there was no statistical difference between groups maybe due to the small patient sample&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The subjective assessment performed in our trial using the questionnaire designed by Shin et al&#46; showed an improvement in the quality of life in both treatment groups without any differences&#46; In our study&#44; patients in both groups showed more than 80&#37; improvement in the epiphora at 6 weeks follow-up visit&#46; At the end of the follow-up period&#44; 66&#46;7&#37; of patients treated with BoNTA and 65&#37; treated with LTS maintained the epiphora improvement&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In 1998 Boroojerdi published the first report about the use of BoNTA for the treatment of epiphora in a case of aberrant regeneration secondary to peripheral facial nerve palsy&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Later&#44; two retrospective studies with BoNTA &#40;Botox&#174;&#44; Allergan&#41; in epiphora have been published with favorable results&#46; One study was conducted in forty-six patients with gustatory hyperlacrimation &#40;crocodile tears&#41; secondary to aberrant regeneration after facial nerve injury and lacrimal obstruction&#44; with improvement of the epiphora in 74&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The second study included a total of twenty-two eyes of 17 patients only with epiphora secondary to lacrimal outflow obstruction&#44; reporting improvement of the epiphora according to mean Munk score from 3&#46;4 to 1&#46;6 points&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The only prospective study of BoNTA &#40;Botox&#174;&#44; Allergan&#41; in functional epiphora included 14 patients with a follow-up of 13 weeks&#44; achieving a significant subjective reduction of epiphora in 72&#46;2&#37; of patients after BoNTA injection&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Recently&#44; a retrospective study by B&#46; Girard with 42 patients reported a relive of the functional epiphora in 49&#47;60 patients &#40;81&#37;&#41; one week after treatment with BoNTA &#40;Xeomin&#174;&#44; Merz&#41; and at one month mean Munk score reduced from 3&#46;6 to 0&#46;6&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">There are three Botulinum toxins type A commercially available from different pharmaceutical laboratories&#58; OnabotulinumtoxinA &#40;Botox&#174;&#44; Vistabel&#174;&#44; Allergan&#41;&#44; AbobotulinumtoxinA &#40;Dysport&#174;&#44; Azzalure&#174;&#44; Ipsen&#47;Galderma&#41; and IncobotulinumtoxinA &#40;Xeomin&#174;&#44; Bocouture&#174;&#59; Merz&#41;&#46; In contrast to other formulas&#44; IncobotulinumtoxinA is free of complexing proteins&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> that have no therapeutic effect&#44; do not prevent the diffusion of the active neurotoxin and can contribute to the production of antibodies&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> IncobotulinumtoxinA is highly stable and can be stored at room temperature&#46; Different clinical studies have demonstrated the equivalent effect between IncobotulinumtoxinA and OnabotulinumtoxinA&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">A few studies have been published on the application of IncobotulinumtoxinA for epiphora&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> No consensus has been reached regarding the dosage&#46; A wide dose range of 1&#46;5&#8211;7&#46;5 IU has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> It is important to use the minimum dosage of BoNTA that improves epiphora and doesn&#8217;t disseminate to the adjacent tissues in order to avoid possible side effects like ptosis and diplopia&#46; It has also been published the need of repeated treatment with BoNTA&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14&#44;22</span></a> even with additional benefit and safety&#46; Regardless of the duration of action&#44; one might assume that the effect of botulinum toxin will wear off over time&#44; therefore is necessary to repeat an injection to achieve relief&#44; not forgetting the additional cost involved&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Regarding the effectiveness of the treatments&#44; the time without epiphora after the interventions was slightly greater with BoNTA &#40;26&#46;2 weeks&#41; when compared to LTS &#40;24&#46;8 weeks&#41;&#44; without reaching statistical significance&#46; Based on retrospective studies&#44; other authors have reported a longer and very variable duration with BoNTA &#40;4&#8211;44 weeks&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;25</span></a> It&#8217;s striking that the average subjective duration of the LTS effect in our trial is relatively short&#44; being a surgical procedure&#46; In addition&#44; since botulinum toxin has a limited duration&#44; one might assume that the LTS would likely become more effective that BoNTA over time&#46; Most of the studies that measure the time without epiphora after surgical correction of eyelid laxity are retrospective&#44; some of them report cases without symptoms with a mean follow-up of 67&#46;6 weeks<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> or 11&#46;2 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Finally&#44; for the safety analysis&#44; we had 5 patients from BoNTA treatment group with AE &#40;41&#46;7&#37;&#41;&#44; with lid ptosis being the main complication in 3 patients&#46; The AE are temporary&#44; lasting for 28&#8211;34 days&#46; In agreement with other case series&#44; there were no diplopia in our study&#46; In the LTS treatment group we had 4 patients with AE &#40;30&#46;8&#37;&#41;&#44; 3 were scar discomfort and the other was a conjunctivitis&#46; No severe AE were noted&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Quantification of epiphora was the main limitation of this study&#44; as no reliable and reproducible methods have been described in the literature&#46; Only subjective assessment as Munk scale and different questionnaires of quality of life can be used&#46; The most extended objective method is the Schirmer test&#44; but without any correlation with the subjective symptomatology and it should even be noted that it is a dry eye method&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Alternative objective methods are needed for a better analysis of epiphora&#44; such as measurement of tear osmolarity or tear meniscus height&#46; These methods are already used but with the limitation of a clear correlation with the degree of epiphora in a subjective way&#46; Another limitation to our study was the small sample size of patients included and the lack of blinding&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Although many ophthalmologists use the LTS procedure for the management of functional epiphora&#44; the results of this study suggest that the efficacy and duration of BoNTA treatment is similar or even slightly greater when assessed with of Munk score at 6 and 12 weeks of treatment&#44; but it may be difficult to establish general rules based on such a small cohort&#46; In addition&#44; LTS can produce iatrogenic that can sometimes increase epiphora by damaging delicate structures such as the lower eyelid retractors as the conjunctiva&#46; The BoNTA injection into the lacrimal gland is an easy treatment to perform&#44; relatively cheap and less invasive than LTS surgery&#44; with a good tolerability and rare side effects of mild intensity&#46; Therefore&#44; BoNTA can be considered the best or only solution to the functional epiphora&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Larger multicentric studies should be conducted to achieve more scientific evidence and to assess the utility of re-injections to improve the quality of life of patients with functional epiphora&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0195" class="elsevierStylePara elsevierViewall">Treatment with BTA is safe and effective for our patients with functional epiphora&#44; providing evidence in our sample of greater effectiveness after six and twelve weeks of treatment compared with LTS&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The study was partially supported by <span class="elsevierStyleGrantSponsor" id="gs0005">Merz pharma Spain Company</span> that donated the Xeomin and supported statistical contribution and liability insurance of the trial&#46; The following authors have no financial disclosures&#58; Borja Maroto Rodr&#237;guez&#44; Bazil TL Stoica&#44; Nicol&#225;s Toledano Fern&#225;ndez and Ignacio Genol Saavedra&#46; All authors attest that they meet the current ICMJE criteria for authorship&#46; The authors declare no funding or conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1776906"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1560162"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1776907"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1560163"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:3 [
              "identificador" => "sec0015"
              "titulo" => "Procedure and follow-up"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0020"
                  "titulo" => "Technique for injection of BoNTA"
                ]
                1 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Surgical technique for LTS"
                ]
              ]
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Study endpoints"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Sample size calculation and statistica analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-01-12"
    "fechaAceptado" => "2022-03-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1560162"
          "palabras" => array:4 [
            0 => "Functional epiphora"
            1 => "Botulinum toxin-A"
            2 => "Lateral tarsal strip"
            3 => "Munk score"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1560163"
          "palabras" => array:4 [
            0 => "Ep&#237;fora funcional"
            1 => "Toxina botul&#237;nica tipo A"
            2 => "Tiratarsal lateral"
            3 => "Escala de Munk"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">To compare the efficacy of botulinum toxin A &#40;BoNTA&#41; injection into the lacrimal gland versus lateral tarsal strip &#40;LTS&#41; for functional epiphora&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Randomized clinical trial&#46; Sequential&#44; parallel&#44; non-blinded study design&#46; Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale &#40;MS&#41; were randomized to BoNTA or LTS group&#46; Changes in Munk scale&#44; Schirmer test &#40;ST&#41; and quality of life &#40;QoL&#41; were assessed at week 6 and during follow-up until week 30&#46; The mean time without epiphora and the adverse events &#40;AE&#41; were recorded&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">The final analysis included 25 patients&#44; 12 &#40;21 eyes&#41; assigned to BoNTA &#40;5U&#47;0&#46;05&#8239;mL&#41; and 13 &#40;20 eyes&#41; to LTS&#46; At 6 weeks there was an improvement in the MS in BoNTA versus LTS group &#40;&#8722;2&#46;48 vs &#8722;1&#46;55&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0152&#41; and at 12 weeks &#40;&#8722;2&#46;68 vs &#8722;1&#46;69&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0267&#41;&#46; A significant decrease was noted in the ST at week 2&#44; 12 and 30 with BoNTA&#46; The QoL improved after both interventions without statistical significance&#46; The mean duration of effectiveness in BoNTA group was 26&#46;2 weeks &#40;range 7&#46;7&#8211;36&#46;6&#41; and in LTS group was 24&#46;8 weeks &#40;range 6&#46;7&#8211;37&#46;6&#41;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;937&#46; The main AE were temporary eyelid ptosis in 25&#37; &#40;3&#47;12&#41; of the BoNTA group and surgical scar discomfort in 23&#37; &#40;3&#47;13&#41; of the LTS groups&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;722&#46; No AE were classified as severe&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">BoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora&#44; with a greater decrease in MS at 6 and 12 weeks compared with LTS&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Comparar la eficacia de la inyecci&#243;n de toxina botul&#237;nica A &#40;TBA&#41; en la gl&#225;ndula lagrimal con la tira tarsal lateral &#40;TTL&#41; en la ep&#237;fora funcional&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Ensayo cl&#237;nico randomizado&#46; Dise&#241;o secuencial&#44; paralelo y no ciego&#46; Pacientes de 18 a&#241;os o m&#225;s con ep&#237;fora funcional con un m&#237;nimo de 3 en la escala de Munk &#40;EM&#41; se incluyeron a grupo de TBA o TTL&#46; Cambios en la escala de Munk&#44; test de Shirmer &#40;TS&#41; y calidad de vida &#40;CV&#41; se evaluaron a la semana 6 hasta la semana 30&#46; Se obtuvo el tiempo medio sin ep&#237;fora y los acontecimientos adversos &#40;AA&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis final incluy&#243; 25 pacientes&#44; 12 &#40;21 ojos&#41; se asignaron a TBA &#40;5U&#47;0&#46;05&#8239;mL&#41; y 13 &#40;20 ojos&#41; a TTL&#46; A la semana 6 hubo un mayor descenso en la EM en el grupo de TBA frente a TTL &#40;&#8722;2&#46;48 vs &#8722;1&#46;55&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0152&#41; y a las 12 semanas &#40;&#8722;2&#46;68 vs &#8722;1&#46;69&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0267&#41;&#46; Se observ&#243; un descenso significativo en el TS a la semana 2&#44;12 y 30 con TBA&#46; La CV mejor&#243; despu&#233;s de ambas intervenciones sin diferencias significativas&#46; El tiempo medio sin ep&#237;fora en el grupo TBA fue 26&#46;2 semanas &#40;7&#46;7&#8211;36&#46;6&#41; y en el grupo TTL 24&#46;8 semanas &#40;6&#46;7&#8211;37&#46;6&#41;&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;9368&#46; Se observ&#243; ptosis temporal en un 25&#37; &#40;3&#47;12&#41; en el grupo TBA y 23&#37; &#40;3&#47;13&#41; de molestias de la cicatriz quir&#250;rgica en el grupo TTL&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;722&#46; Ning&#250;n AA fue severo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">La inyecci&#243;n de TBA en la gl&#225;ndula lagrimal es efectiva y segura en el tratamiento de la ep&#237;fora funcional&#44; con mayor descenso en la EM a las 6 y 12 semanas comparado con la TTL&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Maroto Rodr&#237;guez B&#44; Stoica BTL&#44; Toledano Fern&#225;ndez N&#44; Genol Saavedra I&#46; Tratamiento de la ep&#237;fora funcional con toxina botul&#237;nica tipo A frente a la tira tarsal en un ensayo aleatorizado&#46; Arch Soc Esp Oftalmol&#46; 2022&#59;97&#58;549&#8211;557&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2149
            "Ancho" => 2508
            "Tamanyo" => 420677
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Disposition of patients showing randomization&#44; number of patients completing or withdrawing from the trial and follow-up&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1166
            "Ancho" => 2341
            "Tamanyo" => 137953
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Munk scales evolution&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Botulinum toxin A group &#40;BoNTA&#41;&#58; The mean Munk score significantly decreased at all follow-up period &#40;all weeks <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;0001&#41;&#46; Lateral tarsal strip group &#40;LTS&#41;&#58; The mean Munk score significantly decreased at all follow-up period &#40;week 2 and 6 <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;0001&#44; week 12 <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0003&#44; week 18 <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;002&#44; week 24 <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0002&#44; week 30 <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0002&#41;&#46; Significant differences between groups in week 6 &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0152&#41; and week 12 &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0267&#41;&#46; <span class="elsevierStyleItalic">P</span>-value were calculated with lineal mixed models&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1150
            "Ancho" => 2341
            "Tamanyo" => 144464
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Schirmer test evolution&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Botulinum toxin A group &#40;BoNTA&#41;&#58; The mean Schirmer test significantly decreased at week 2 &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0484&#41;&#44; week 12 &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0182&#41; and week 30 &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;0083&#41;&#46; <span class="elsevierStyleItalic">P</span>-value were calculated with lineal mixed models&#46; Lateral tarsal strip group &#40;LTS&#41;&#58; There were no significant differences at all follow-up&#46; And there were no significant differences between groups&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1281
            "Ancho" => 2341
            "Tamanyo" => 242519
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Global qualitative subjective evaluation&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Subjective scale of improvement of functional epiphora after intervention according to the Global qualitative subjective evaluation&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Fig&#46; 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1042
            "Ancho" => 1405
            "Tamanyo" => 85865
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Treatment duration&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The median duration of effectiveness of both treatments&#46; Survival analysis with the Kaplan Meier method&#46; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;9368&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inclusion criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Patients aged 18 years or older&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Unilateral o bilateral epiphora with a minimum score of 3 on Munk Scale and patent lacrimal drainage system to syringing&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="1" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exclusion criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Pregnancy and breastfeeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Patients with blepharoconjunctivitis with or without keratitis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Eyelid malpositions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Conjunctivochalasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Previous eyelid surgery&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Tear dysfunction syndrome&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- History of ocular or lacrimal system trauma&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Previous dacryocystorhinostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Previous refractive surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Coagulopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Ptosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Ocular motility dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Hypersensitivity to botulinum toxin type A or to any of the excipients of XEOMIN&#174;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Inclusion and exclusion criteria&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BoNTA N&#8239;&#61;&#8239;12&#59; O&#8239;&#61;&#8239;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LTS N&#8239;&#61;&#8239;13&#59; O&#8239;&#61;&#8239;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&#44; years &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;50&#8239;&#177;&#8239;9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;23&#8239;&#177;&#8239;13&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;8757<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender Female&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;100&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;76&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;22 <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Affected eye&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#8224;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;23&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;23&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Both&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;53&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Munk Scale &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;90&#8239;&#177;&#8239;0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;90&#8239;&#177;&#8239;0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;9799 <a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schirmer test&#44; mm &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;24&#8239;&#177;&#8239;6&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;40&#8239;&#177;&#8239;7&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;1545 <a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visual acuity &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&#8239;&#177;&#8239;0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88&#8239;&#177;&#8239;0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;0975 <a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eyelid traction&#44; mm &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;10&#8239;&#177;&#8239;1&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;60&#8239;&#177;&#8239;0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;1055 <a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quality of life score &#40;mean&#8239;&#177;&#8239;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;71&#8239;&#177;&#8239;0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;90&#8239;&#177;&#8239;0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;5873 <a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span>-value were calculated with <span class="elsevierStyleItalic">t</span>-test or Wilcoxon&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#8224;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">P</span>-value were calculated with Chi-square or Fisher test&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Demographic data and baseline characteristics&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of life &#40;General&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean CI95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Change versus baseline&#46; Mean CI95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BoNTA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;71 &#40;2&#46;3&#44; 3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;4&#44; 1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;71 &#40;&#8722;2&#46;2&#44; &#8722;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;35 &#40;0&#46;6&#44; 2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;36 &#40;&#8722;2&#46;3&#44; &#8722;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0074</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;06 &#40;0&#46;1&#44; 2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;65 &#40;&#8722;2&#46;6&#44; &#8722;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0034</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45 &#40;0&#46;1&#44; 0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;18 &#40;&#8722;2&#46;8&#44; &#8722;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38 &#40;0&#46;1&#44; 0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;25 &#40;&#8722;2&#46;9&#44; &#8722;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88 &#40;0&#46;4&#44; 1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;72 &#40;&#8722;2&#46;8&#44; &#8722;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0061</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TLS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;90 &#40;2&#46;3&#44; 3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11 &#40;0&#46;4&#44; 1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;79 &#40;&#8722;2&#46;5&#44; &#8722;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;34 &#40;0&#46;7&#44; 2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;56 &#40;&#8722;2&#46;2&#44; &#8722;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;12 &#40;0&#46;5&#44; 1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;88 &#40;&#8722;2&#46;7&#44; &#8722;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0005</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;93 &#40;0&#46;1&#44; 1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;00 &#40;&#8722;3&#46;0&#44; &#8722;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0021</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90 &#40;0&#46;3&#44; 1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;04 &#40;&#8722;2&#46;7&#44; &#8722;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#46;0002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Week 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83 &#40;0&#46;1&#44; 1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;10 &#40;&#8722;2&#46;7&#44; &#8722;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleItalic">P</span>-value were calculated with Paired <span class="elsevierStyleItalic">t</span>-test or Wilcoxon&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Subjective assessment of quality of life &#40;Shin et al&#46; questionnaire&#41; after interventions&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#8239;&#61;&#8239;Botulinum Toxin A&#59; LTS&#8239;&#61;&#8239;Lateral Tarsal Strip&#59; AE&#8239;&#61;&#8239;Adverse events&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Intensity&#58; Mild&#44; an event that is easily tolerated by the patient&#44; causing minimal discomfort and not interfering with everyday activities&#59; moderate&#44; an event that is sufficiently discomforting to interfere with normal everyday activities&#59; severe&#44; an event that prevents normal everyday activities&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intensity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Relationship&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serious&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BoNTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eyelid ptosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BoNTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eyelid ptosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BoNTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metamorphopsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ongoing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unlike&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BoNTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eyelid ptosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BoNTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conjunctivitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unlike&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conjunctivitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unlike&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical scar discomfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical scar discomfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical scar discomfort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Adverse events&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perspective&#58; what does the term functional mean in the context of epiphora&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46; Chan"
                            1 => "R&#46; Malhotra"
                            2 => "H&#46; Kakizaki"
                            3 => "I&#46; Leibovitch"
                            4 => "D&#46; Selva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1442-9071.2012.02791.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Ophthalmol&#46;"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "749"
                        "paginaFinal" => "754"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22429759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1111/j.1442-9071.2012.02791.x"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;22429759&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower eyelid laxity and ocular symptoms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Liu"
                            1 => "O&#46;G&#46; Stasior"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9394(83)90279-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol&#46;"
                        "fecha" => "1983"
                        "volumen" => "95"
                        "paginaInicial" => "545"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6837700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/0002-9394(83)90279-9"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;6837700&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review on functional epiphora-current understanding and existing lacunae"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Singh"
                            1 => "A&#46;G&#46; Nair"
                            2 => "S&#46; Kamal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Expert Rev Ophthalmol&#46;"
                        "fecha" => "2019"
                        "volumen" => "14"
                        "paginaInicial" => "169"
                        "paginaFinal" => "177"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of functional nasolacrimal duct obstruction&#8211;a survey of ophthalmologists in the southwest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;M&#46; Cuthbertson"
                            1 => "S&#46; Webber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.eye.6700522"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eye&#46;"
                        "fecha" => "2004"
                        "volumen" => "18"
                        "paginaInicial" => "20"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14707959"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508509007197"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/sj.eye.6700522"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;14707959&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and management of &#8220;functional&#8221; nasolacrimal blockage&#58; resuTTL of a survey of the American Society of Ophthalmic Plastic and Reconstructive surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;T&#46; Conway"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthal Plast Reconstr Surg&#46;"
                        "fecha" => "1994"
                        "volumen" => "10"
                        "paginaInicial" => "185"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7947445"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508516347175"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;7947445"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tarsal strip procedure for the correction of tearing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;L&#46; Vick"
                            1 => "J&#46;B&#46; Holds"
                            2 => "M&#46;E&#46; Hartstein"
                            3 => "G&#46;G&#46; Massry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/01.IOP.0000103005.81708.FD"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthal Plast Reconstr Surg&#46;"
                        "fecha" => "2004"
                        "volumen" => "20"
                        "paginaInicial" => "37"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14752308"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/01.IOP.0000103005.81708.FD"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;14752308"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstruction of the lacrimal drainage system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;T&#46;H&#46; Mandeville"
                            1 => "J&#46;J&#46; Woog"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/00055735-200210000-00003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol&#46;"
                        "fecha" => "2002"
                        "volumen" => "13"
                        "paginaInicial" => "303"
                        "paginaFinal" => "309"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12218461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/00055735-200210000-00003"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;12218461"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum A toxin &#40;Oculinum&#174;&#41; in ophthalmology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Osako"
                            1 => "J&#46;L&#46; Keltner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0039-6257(91)90207-v"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surv Ophthalmol&#46;"
                        "fecha" => "1991"
                        "volumen" => "36"
                        "paginaInicial" => "28"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1925943"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Blocking secretion of exocrine glands in the head-neck area by administration of botulinum toxin A&#46; Therapy of a rare disease picture&#93; German"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Ellies"
                            1 => "R&#46; Laskawi"
                            2 => "S&#46; Rohrbach-Volland"
                            3 => "R&#46; R&#246;del"
                            4 => "W&#46; Beuche"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s001060170028"
                      "Revista" => array:7 [
                        "tituloSerie" => "HNO&#46;"
                        "fecha" => "2001"
                        "volumen" => "49"
                        "paginaInicial" => "807"
                        "paginaFinal" => "813"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11699140"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508516347126"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/s001060170028"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;11699140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraglandular injection of botulinum toxin a reduces tear production in rabbits"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Demetriades"
                            1 => "I&#46;M&#46; Leyngold"
                            2 => "S&#46; D&#8217;Anna"
                            3 => "A&#46;O&#46; Eghrari"
                            4 => "D&#46;G&#46; Emmert"
                            5 => "M&#46;P&#46; Grant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/IOP.0b013e31826e8a86"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthal Plast Reconstr Surg&#46;"
                        "fecha" => "2019"
                        "volumen" => "29"
                        "paginaInicial" => "21"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23128538"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/IOP.0b013e31826e8a86"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;23128538"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of epiphora on vision-related quality of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;-H&#46; Shin"
                            1 => "Y&#46;-D&#46; Kim"
                            2 => "K&#46;I&#46; Woo"
                            3 => "Korean Society of Ophthalmic Plastic and Reconstructive Surgery &#40;KSOPRS&#41;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2415-15-6"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Ophthalmol&#46;"
                        "fecha" => "2015"
                        "volumen" => "15"
                        "paginaInicial" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25613683"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1186/1471-2415-15-6"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;25613683"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin injection for the treatment of epiphora in lacrimal outflow obstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Ziahosseini"
                            1 => "Z&#46; Al-Abbadi"
                            2 => "R&#46; Malhotra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/eye.2015.18"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eye &#40;Lond&#41;&#46;"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "656"
                        "paginaFinal" => "661"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25744443"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/eye.2015.18"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;25744443"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphora"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Singh"
                            1 => "A&#46;G&#46; Nair"
                            2 => "M&#46;S&#46; Alam"
                            3 => "B&#46; Mukherjee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/ojo.OJO_52_2018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oman J Ophthalmol&#46;"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "104"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31198296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum neurotoxin A injection for the treatment of epiphora with patent lacrymal ducts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Girard"
                            1 => "J&#46;M&#46; Piaton"
                            2 => "P&#46; Keller"
                            3 => "T&#46;H&#46; Nguyen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jfo.2017.11.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Fr Ophtalmol&#46;"
                        "fecha" => "2018"
                        "volumen" => "41"
                        "paginaInicial" => "343"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29681465"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin treatment of synkinesia and hyperlacrimation after facial palsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Boroojerdi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1136/jnnp.65.1.111"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol Neurosurg Psychiatry&#46;"
                        "fecha" => "1998"
                        "volumen" => "65"
                        "paginaInicial" => "111"
                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9667571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1136/jnnp.65.1.111"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;9667571&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ResuTTL of lacrimal gland botulinum toxin injection for epiphora in lacrimal obstruction and gustatory tearing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;H&#46; Wojno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/IOP.0b013e318201d1d3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthal Plast Reconstr Surg&#46;"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "119"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21224749"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/IOP.0b013e318201d1d3"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;21224749"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of botulinum toxin A in the treatment of functional epiphora"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;W&#46; Whittaker"
                            1 => "B&#46;N&#46; Matthews"
                            2 => "A&#46;W&#46; Fitt"
                            3 => "S&#46; Sandramouli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1076/orbi.22.3.193.15622"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orbit&#46;"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "193"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12868028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1076/orbi.22.3.193.15622"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;12868028"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Benecke"
                            1 => "W&#46;H&#46; Jost"
                            2 => "P&#46; Kanovsky"
                            3 => "E&#46; Ruzicka"
                            4 => "G&#46; Comes"
                            5 => "S&#46; Grafe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/01.WNL.0000163767.99354.C3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology&#46;"
                        "fecha" => "2005"
                        "volumen" => "64"
                        "paginaInicial" => "1949"
                        "paginaFinal" => "1951"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15955951"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum neurotoxin type A free of complexing proteins &#40;XEOMIN&#174;&#41; in focal dystonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;H&#46; Jost"
                            1 => "J&#46; Bl&#252;mel"
                            2 => "S&#46; Grafe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/00003495-200767050-00003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs&#46;"
                        "fecha" => "2007"
                        "volumen" => "67"
                        "paginaInicial" => "669"
                        "paginaFinal" => "683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17385940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term efficacy and tolerability of 4-monthly versus yearly botulinum toxin type A treatment for lower-limb spasticity in children with cerebral palsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Ka&#328;ovsk&#253;"
                            1 => "M&#46; Bare&#353;"
                            2 => "S&#46; Severa"
                            3 => "A&#46; Richardson"
                            4 => "J&#46; Kraus"
                            5 => "S&#46; Severa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1469-8749.2008.03264.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Dev Med Child Neurol&#46;"
                        "fecha" => "2009"
                        "volumen" => "51"
                        "paginaInicial" => "436"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19563586"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673602114371"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1111/j.1469-8749.2008.03264.x"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;19563586&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparing incobotulinumtoxinA &#40;Xeomin&#174;&#41; and onabotulinumtoxinA &#40;Botox&#174;&#41;&#58; identical potency labelling in the hemidiaphragm assay"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Dressler"
                            1 => "L&#46; Pan"
                            2 => "H&#46; Bigalke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00702-018-1897-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Neural Transm&#46;"
                        "fecha" => "2018"
                        "volumen" => "125"
                        "paginaInicial" => "1351"
                        "paginaFinal" => "1354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29946929"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0022346815007654"
                          "estado" => "S300"
                          "issn" => "00223468"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Repeated injections of botulinum toxin-A for epiphora in lacrimal drainage disorders&#58; qualitative and quantitative assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ahn"
                            1 => "S&#46; Kang"
                            2 => "H&#46;S&#46; Sa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/s41433-019-0362-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eye&#46;"
                        "fecha" => "2019 Jun"
                        "volumen" => "33"
                        "paginaInicial" => "995"
                        "paginaFinal" => "999"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30765885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/s41433-019-0362-x"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;30765885"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traitement par la toxine botulique du larmoiement &#224; voies lacrymales obstru&#233;es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Girard"
                            1 => "J&#46;M&#46; Piaton"
                            2 => "P&#46; Keller"
                            3 => "C&#46; Abadie"
                            4 => "T&#46;H&#46; Nguyen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jfo.2017.03.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Fr Ophtalmol&#46;"
                        "fecha" => "2017"
                        "volumen" => "40"
                        "paginaInicial" => "661"
                        "paginaFinal" => "665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28847443"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long term efficacy and safety of botulinum toxin A injection for crocodile tears syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;E&#46; Bara&#241;ano"
                            1 => "N&#46;R&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjo.2003.029181"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Ophthalmol&#46;"
                        "fecha" => "2004"
                        "volumen" => "88"
                        "paginaInicial" => "588"
                        "paginaFinal" => "589"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15031188"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612601500"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based review and assessment of botulinum neurotoxin for the treatment of secretory disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Naumann"
                            1 => "D&#46; Dressler"
                            2 => "M&#46; Hallett"
                            3 => "J&#46; Jankovic"
                            4 => "G&#46; Schiavo"
                            5 => "K&#46;R&#46; Segal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.toxicon.2012.10.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Toxicon&#46;"
                        "fecha" => "2013"
                        "volumen" => "67"
                        "paginaInicial" => "141"
                        "paginaFinal" => "152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23178324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epiphora with eyelid laxity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Narayanan"
                            1 => "E&#46;A&#46; Barnes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1080/01676830500192126"
                      "Revista" => array:6 [
                        "tituloSerie" => "Orbit&#46;"
                        "fecha" => "2005"
                        "volumen" => "24"
                        "paginaInicial" => "201"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16169807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1080/01676830500192126"
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed&#47;16169807"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of patients with dry eye for the presence of primary or secondary sj&#1255;gren&#8217;s syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;M&#46; Abd-Allah"
                            1 => "A&#46;A&#46; Hassan"
                            2 => "G&#46; Omar"
                            3 => "M&#46; Hamdy"
                            4 => "S&#46;T&#46;A&#46; Abdelaziz"
                            5 => "W&#46;M&#46;A&#46; El Hamid"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/OPTH.S217433"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Ophthalmol&#46;"
                        "fecha" => "2019"
                        "volumen" => "13"
                        "paginaInicial" => "1787"
                        "paginaFinal" => "1797"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31571817"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735794/0000009700000010/v1_202209300752/S2173579422001116/v1_202209300752/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5816"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009700000010/v1_202209300752/S2173579422001116/v1_202209300752/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422001116?idApp=UINPBA00004N"
]
Indexed in:

Follow us:

Subscribe:

Purchase article

Indexed in:

Follow us:

Subscribe:

Purchase article

Subscribe to our newsletter
