Botulinum A Toxin Injection into Extraocular Muscles as an Alternative to Strabismus Surgery

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Abstract
In this chapter a case series is described of the use of botulinum A toxin for the treatment of strabismus in 19 patients with multiple types of strabismus with different etiologies. The maximum follow-up following botulinum injection was six months. Injection of botulinum A toxin into extraocular muscle to weaken the muscle was found to be a safe and effective alternative (or adjunct) to surgery for strabismus correction. The maximum time of paralysis occurred four to five days following the injection, and then gradually diminished, depending on the dose. The maximum correction of strabismus was 40 prism diopters. This was the first case series describing the use of botulinum A toxin for strabismus correction, and it led the way to further studies on the subject, which eventually led to FDA approval in 1990.

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