Treatment of strabismus and nystagmus with botulinum toxin type A. An evaluation of effects and complications.

PURPOSE Injection of botulinum toxin type A into eye muscles leads to a temporary paralysis and the effects have been evaluated in strabismus or nystagmus. METHOD A total of 112 patients with different types of concomitant and paralytic strabismus and acquired nystagmus were treated with botulinum toxin, according to well-established indications. RESULTS The lasting effects of the injections on strabismic angle were largest in esotropia, consecutive exotropia and abducens palsy, and amounted to, on an average, 12 prism diopters or 6 degrees. The larger the strabismus the better was the effect. Repeated injections reduced the angle further. In complex nystagmus forms retrobulbar injections could be used. The side effects were mostly due to spread of botulinum toxin to the levator, producing ptosis (8%), or the inferior rectus muscle, causing vertical strabismus (10%). On an average 42% of the patients were later operated for strabismus and nystagmus. CONCLUSION Injection of botulinum toxin A into eye muscles is a valuable adjunct to surgery in the treatment of strabismus and nystagmus.

[1]  J. Carruthers,et al.  The treatment of congenital nystagmus with Botox. , 1995, Journal of pediatric ophthalmology and strabismus.

[2]  M. Repka,et al.  Treatment of acquired nystagmus with botulinum neurotoxin A. , 1994, Archives of ophthalmology.

[3]  J. Cohen,et al.  Results of a prospective randomized trial of botulinum toxin therapy in acute unilateral sixth nerve palsy. , 1994, Journal of pediatric ophthalmology and strabismus.

[4]  R. Spencer,et al.  Observations on bilateral simultaneous botulinum toxin injection in infantile esotropia. , 1994, Journal of pediatric ophthalmology and strabismus.

[5]  J. Elston,et al.  The use of botulinum toxin for treatment of acquired nystagmus and oscillopsia. , 1994, Ophthalmology.

[6]  M. Ing.  Botulinum alignment for congenital esotropia. , 1993, Ophthalmology.

[7]  J. Lee.  Modern management of sixth nerve palsy. , 1992, Australian and New Zealand journal of ophthalmology.

[8]  D. Stager,et al.  Botulinum treatment of childhood strabismus. , 1990, Ophthalmology.

[9]  R. Saunders,et al.  Management of strabismus with botulinum A toxin. , 1989, Ophthalmology.

[10]  B. Kushner,et al.  Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy. , 1989, Archives of ophthalmology.

[11]  E. Helveston,et al.  Treatment of acquired nystagmus with botulinum A toxin. , 1988, American journal of ophthalmology.

[12]  J. P. Lee,et al.  Treatment of sixth nerve palsy in adults with combined botulinum toxin chemodenervation and surgery. , 1988, Ophthalmology.

[13]  P. O'Connor,et al.  Botolinum Toxin for the Treatment of Dysthyrolod Ocular Myopathy , 1986 .

[14]  S. Lerman,et al.  Botulinum chemodenervation treatment of strabismus. , 1985, Journal of pediatric ophthalmology and strabismus.

[15]  J. P. Lee,et al.  Treatment of strabismus in adults with botulinum toxin A. , 1985, The British journal of ophthalmology.

[16]  A. B. Scott,et al.  Botulinum toxin injection in the management of lateral rectus paresis. , 1985, Ophthalmology.

[17]  A. B. Scott,et al.  Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. , 1980, Ophthalmology.

[18]  A. Sanaç,et al.  Factors influencing success and dose-effect relation of botulinum a treatment , 1996, Eye.

[19]  J. P. Lee,et al.  Botulinum toxin therapy in dysthyroid strabismus , 1990, Eye.

[20]  Scott Ab.  Botulinum toxin injection of eye muscles to correct strabismus. , 1981 .