Use of botulinum toxin in strabismus.
OBJECTIVE
The history, pharmacology, indications, complications, and success rates of botulinum administration are discussed in this review as they relate to strabismus and associated conditions.


RESULTS
Botulinum has been used to treat strabismus and a variety of other ocular conditions for over three decades. Alan Scott initially investigated extraocular muscle paralysis by botulinum injection in 1973, and in the ensuing years botulinum has been evaluated as a treatment for horizontal and vertical strabismus, nystagmus, dissociated vertical deviation, sensory strabismus, ophthalmoplegia, and paradoxical diplopia.


CONCLUSIONS
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.
Crouch
Eric R
ER
Eastern Virginia Medical School, Ophthalmology Department, Norfolk, Virginia 23502, USA. ercrouch@gmail.com
D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009801:Oculomotor Muscles / Q000187:drug effects*; D013285:Strabismus / Q000188:drug therapy*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A