[Bilateral superior oblique palsy and botulinum toxin].
OBJECTIVE
To study the effectiveness of botulinum toxin in the treatment of bilateral acquired oblique superior palsy.


METHODS
Five patients with bilateral asymmetrical acquired superior oblique palsy were treated with periodical injections of botulinum toxin in the inferior oblique and rectus muscles (2.5-5 U). The average age of the sample was 37.4 years. A trauma etiology was present in four cases. Treatment was applied at two months after the beginning of the illness in two cases, at four months in another two cases, and at one year in the other patient.


RESULTS
A good result was achieved in three of the cases with botulinum toxin. Two patients required surgery. All of the patients were injected in the inferior obliques, and two cases were also injected in the inferior rectus. The number of injections ranged between four and six applications. It was considered to be a good result when diplopia was corrected in reading and primary position, and torticollis disappeared. Diplopia was not corrected in extreme lateral gazes and supraversion in two cases.


CONCLUSIONS
Periodical botulinum toxin injections represent an alternative management to surgery in the treatment of bilateral acquired oblique palsy. In some cases botulinum toxin injections can prevent or decrease the number of surgical interventions
Merino
P
P
Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, Spain. jacobo@oftalmored.com
Gómez de Liaño
P
P
García
C
C
Bartolomé
G
G
Rodríguez
C
C
De Juan
L
L
D000328:Adult; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004172:Diplopia / Q000188:drug therapy* / Q000601:surgery; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000187:drug effects; D016896:Treatment Outcome; D020432:Trochlear Nerve Diseases / Q000188:drug therapy* / Q000601:surgery
D001905:Botulinum Toxins