Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis.
OBJECTIVE
Botulinum toxin (BTX), injected into the ipsilateral medial rectus muscle, has been advocated for the management of acute traumatic sixth nerve palsy or paresis. We conducted a multicenter, nonrandomized, data collection study to evaluate recovery rates of patients treated with either conservative measures or BTX.


METHODS
All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis during a 2-year period (between March 1996 and February 1998). The BTX group was defined as patients who received a BTX injection within 3 months of injury. Recovery at 6 months from injury was defined as absence of diplopia in the primary position and a distance esotropia of no more than 10 PD in the primary position. Nonrecovered patients with less than 6 months of follow-up (n = 15) were excluded.


RESULTS
Eighty-four eligible patients were enrolled by 46 investigators. Sixty-two patients (74%) were treated conservatively and 22 (26%) with BTX. Sixty-two patients (74%) had unilateral palsy, and 22 (26%) had bilateral palsy. Recovery rates were similar between BTX and conservatively treated patients (overall: 73% vs 71%, P = 1.0; unilateral: 81% vs 83%, P = 1.0; bilateral: 50% vs 38%, P = 0.66, respectively).


CONCLUSIONS
In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, patients treated with either BTX or conservative measures had similar high recovery rates.
Holmes
J M
JM
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. holmes.jonathan@mayo.edu
Beck
R W
RW
Kip
K E
KE
Droste
P J
PJ
Leske
D A
DA
D020222:Abducens Nerve Injury / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D004172:Diplopia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004948:Esotropia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000187:drug effects* / Q000294:innervation; D011446:Prospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins