The lacrimal nerve is a branch of the ophthalmic division of the trigeminal nerve (V1) that enters the orbit through the superior orbital fissure and runs along the superior border of the lateral rectus muscle to the lacrimal gland, lateral eyelid, and conjunctiva. It carries sensory fibres from the lateral eyelid and receives parasympathetic secretomotor fibres from the zygomaticotemporal nerve (zygomatic branch of V2) via the pterygopalatine ganglion for lacrimal gland secretion.
The lacrimal nerve parasympathetic pathway from the pterygopalatine ganglion to the lacrimal gland via the lacrimal nerve is disrupted in Bell's palsy and in facial nerve surgery, producing ipsilateral dry eye from lacrimal gland denervation. In Frey syndrome (auriculo-temporal syndrome), aberrant regeneration of parotid parasympathetic fibres into the sweat glands of the cheek produces gustatory sweating — an analogous phenomenon to lacrimal nerve involvement. The lacrimal nerve is also the pathway for crocodile tears (paradoxical lacrimation) when facial nerve fibres regenerate aberrantly to the lacrimal gland after Bell's palsy.
After Bell's palsy recovery, aberrant facial nerve regeneration connects salivatory fibres to the lacrimal gland via the greater superficial petrosal nerve and lacrimal nerve pathway, producing inappropriate lacrimation during meals (crocodile tears); patients notice tearing with eating rather than eye moistening at rest, and botulinum toxin to the lacrimal gland treats severe cases.
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