title: [Bilateral superior oblique palsy and botulinum toxin].
abstract: 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
authors.affiliation: Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, Spain. jacobo@oftalmored.com
authors.forename: P
authors.initials: P
authors.lastname: Merino
authors.forename: P
authors.initials: P
authors.lastname: Gómez de Liaño
authors.forename: C
authors.initials: C
authors.lastname: García
authors.forename: G
authors.initials: G
authors.lastname: Bartolomé
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez
authors.forename: L
authors.initials: L
authors.lastname: De Juan
mesh_terms: 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
chemical_list: D001905:Botulinum Toxins