Use of botulinum toxin in strabismus

Abstract

Botulinum administration is a strabismus treatment option that may be considered for some strabismus patients; in select cases botulinum is a reasonable and preferable alternative to surgery. Current clinical recommendations regarding botulinum should be considered in the context of the existing comparative studies that are summarized in this review. Since there are very limited data directly comparing the success rates of botulinum with standard strabismus surgery, additional, well designed prospective studies are needed. Data from such studies would enable recommendations for strabismus management to be formulated using an evidence-based approach.

Ultrastructural changes in myotendinous nerve endings induced by injection of botulinum toxin into the extraocular muscle

“…Injection of botulinum toxin into the EOM is used for the treatment of various types of strabismus by inducing a temporary flaccid paralysis [15,16]. When botulinum toxin is injected into the EOM, the muscle loses contractility, The axon is incompletely covered by a fibroblast-like cell (arrow).…”

“…The resulting muscle paralysis is temporary, with muscles typically being reinnervated within 46 to 60 days [15]. Taking advantage of this temporary paralytic effect, botulinum toxin can be used in the treatment of acute paretic strabismus, strabismus with multiple surgeries, and strabismus with risk of anterior segment ischemia [16].…”

The Uses and Application Methods of Botulinum Toxin in Ophthalmology

“…Paralitik şaşılıklar, postoperatif konsekütif şaşılıklar, 40 prizm dioptriden az kayması olanlarda, siklik ezotropya ve çoklu şaşılık cerrahisi geçirmiş komplike hastalarda kullanıla-bilmektedir. 30 Ortalama BTX dozu her bir kasa 1-3 MU'dur. 30 Yüksek dozlarda komplikasyon sıklığı artmaktadır.…”

Efficacy of Botulinum Toxin A Injection in Horizontal Strabismus

“…Since then, BTX has become widely used in blepharospasm, pain syndromes, and facial aesthetics. Presently BTX A is preferred due to its easy administration and transient side effects (1,4) .…”

“…Of the seven serotypes, only the BTX serotype A (BTX A) can be used in clinical practice (1,3) . BTX A neurotoxin has a molecular weight of 150 kDa and prevents the acetylcholine release from peripheral cholinergic nerve terminals causing reversible muscle paralysis (4) . In ophthalmology, BTX was initially used by Alan Scott at the Smith Kettlewell Institute in San Francisco to treat strabismus in primates in 1973.…”