Jan. 29, 2009 -- Patricia Webster's struggle with the degenerative nerve condition known as Guillain-Barre syndrome has been a constant battle for the past 18 years. She has endured paralysis, a three-month-long hospital stay, lingering facial spasms and more.
But Webster, a 58-year-old mother of three who lives in Maidstone, England, said that for years, one of the most mortifying and perplexing symptoms of her condition came about whenever she sat down for a meal.
Specifically, whenever she ate or had a drink, tears would begin rolling down her face.
"For the last 18 years of my life I've done nothing, and the embarrassment of my eyes was a major part of this," she said. "I was fed up with people coming up to me and asking, 'What's wrong?' I'm not the sort of person who cries in public when I want attention."
Webster's doctors, too, were baffled by the unusual condition. At one point, an ophthalmologist told Webster that her only option would be major surgery on her eyes, which would have led to significant recovery time and scarring. And, even then, there was no guarantee that this extreme option would even work.
But two years ago, one of Webster's physicians offered a novel suggestion -- shots of Botox, delivered directly into the tear gland.
"Of course, I'm thinking, 'Botox ... it's a cosmetic treatment.' I thought, 'He's not worried about my eye, he's telling me that I'm wrinkly,'" Webster said, laughing.
But the results, it turned out, were no joke.
"It worked instantly," she said. "To coin a phrase, I couldn't believe my eyes."
While Botox, the brand name of the botulinum toxin produced by Allergan, is most often associated with its cosmetic applications, the original use of the drug was actually for nerve and muscle conditions like the one Webster experienced. The drug itself is a paralytic agent, and injecting it into a muscle effectively cuts the nerve signals that cause the muscle to contract.
For some, this means relief from a spastic muscle, or even a tension-induced headache. For Webster, it meant a stop to her unwanted tears.
An Eating-Induced Illness
Margaret Gurney, the nurse practitioner at Maidstone and Pembury hospitals who has been treating Webster for the past three years, says she has seen other patients who have experienced eating-induced hyperlacrimation, a condition commonly referred to as "crocodile tears."
Gurney said that while the Botox treatment does not work 100 percent of the time, it does relieve symptoms in some patients.
"There are not many people doing Botox for this condition," Gurney said. "Not many people know about it."
The Cause for 'Crocodile Tears'
For Webster, the tears that she experienced while she ate were only one debilitating aspect of the disease that stripped the protective covering known as the myelin sheath from her nerves.
The myelin sheath acts a bit like the protective covering on a wire. Strip this covering off of the wire, and it becomes more prone to damage. Worse, it can also become tangled with other wires, making it more likely that signals will get crossed.
Webster was diagnosed with a particularly rare variant of Guillain-Barre known as Miller Fisher syndrome. Unlike the normal form of the condition, in which muscle problems tend to spread from the legs upward, Miller Fisher is associated with paralysis of the eye muscles and other related problems.
Even then, the uncontrolled production of tears while eating is a very rare symptom.
"It's something that I've never seen," said Barbara Coslow, a nurse practitioner at William Beaumont Hospital, in Royal Oak, Mich., who also works with patients who have Guillain-Barre.
The first sign of Webster's condition came in April 1991 in the form of extremely bad headaches. The headaches worsened, and with them came the paralysis of other muscles throughout her body.
"I had three months in the hospital when I was totally paralyzed," Webster recalled, adding that she also suffered from a condition known as blepharospasm, which affected the muscles of her eyes.
"The muscles either decided to clamp shut, which would render me temporarily blind, or they would not shut at all," she said. "The nurses would have to put tape from my eyelids down onto my cheek in order to hold my eyelids shut."
Incorrect Brain Signals
While she eventually became well enough to leave the hospital, the mixed and incorrect signals between her brain and the tiny nerves in her face posed lingering problems. "It was like my nerves were being short-circuited," Webster said.
When her eye problems were at their worst, she said, her tear ducts would become easily blocked, leading her to appear as if she "had been punched in both eyes."
This appearance, combined with the tears that streamed forth whenever Webster ate, took a dramatic toll on her social life.
"This was very socially isolating for her because she couldn't go out for dinner or anything like that," Gurney, the nurse practitioner, said.
Webster said, "Before I went into the hospital, I was gregarious. When I came out of the hospital, it was quite the contrary; I was quite withdrawn."
After the Tears: Getting Back to Normal Life
These days, Webster must visit the clinic every 12 to 20 weeks for a repeat injection. And the treatment is not without its risks; Gurney said she is reluctant to treat patients like Webster too often with Botox injections into the tear gland because injecting too often can lead to scarring.
But Michigan's Coslow said that there is little debate that Botox injections can help many of those who struggle with Guillain-Barre, even if it is only a temporary measure.
"Many times, we do therapy along with it," Coslow said. "This could provide some benefit while the body is healing and until [patients] get normal function back."
And, for Webster, the treatment offered nothing short of a chance to live a more normal life.
"It totally changed everything," she said. "Suddenly, I could do many of the normal things I had before."
"I wish my whole person would change back to what it used to be."