title: Optic neuropathy associated with botulinum A toxin in thyroid-related orbitopathy.
abstract: OBJECTIVE
  To report the development of optic neuropathy after botulinum A toxin injection for restrictive myopathy from thyroid-related orbitopathy (TRO).
  
  
  METHODS
  We retrospectively reviewed the records of three patients with TRO who underwent botulinum A toxin injection for restrictive myopathy and subsequently developed optic neuropathy. Development of optic neuropathy was measured by visual acuity, color vision testing, visual field testing, and relative afferent pupillary testing.
  
  
  RESULTS
  At 3 week follow-up after botulinum A toxin injection, three patients were noted to have clinical signs and symptoms of optic neuropathy in the ipsilateral eye following injection of botulinum A toxin for restrictive myopathy. Treatment with oral steroids followed by orbital wall decompression reversed the optic neuropathy.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of optic neuropathy associated with botulinum A toxin injection in TRO. Clinicians should be aware of this potential vision threatening complication.
authors.affiliation: Thyroid Eye Center, Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California 92093-0946, USA.
authors.forename: Bobby S
authors.initials: BS
authors.lastname: Korn
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Seo
authors.forename: Leah
authors.initials: L
authors.lastname: Levi
authors.forename: David B
authors.initials: DB
authors.lastname: Granet
authors.forename: Don O
authors.initials: DO
authors.lastname: Kikkawa
mesh_terms: D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D003119:Color Perception Tests; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity; D014794:Visual Fields
chemical_list: D005938:Glucocorticoids; D019274:Botulinum Toxins, Type A; D011241:Prednisone