The role of Botulinum toxin in management of acute traumatic third-nerve palsy.
OBJECTIVE
To study the effect of botulinum toxin A injection in the management of paralytic exotropia resulting from acute traumatic third (oculomotor) nerve palsy.


METHODS
Nine patients with acute traumatic partial third-nerve palsy of less than 2 months' duration were treated by injection of botulinum toxin A into the ipsilateral lateral rectus muscle. The horizontal deviation angles before and after the injections were recorded. A distance exotropia of less than 10(Delta) or absence of diplopia in the primary position at the last follow-up was defined as recovery.


RESULTS
The mean preinjection deviation in the primary position was 48.3(Delta) of exotropia, and the mean postinjection deviation in the primary position was 14.2(Delta) at the last follow-up. Seven patients experienced recovery and regained single binocular vision in the primary position. The overall recovery rate was 77.8%. Two patients did not recover and subsequently underwent strabismus surgery.


CONCLUSIONS
Patients with acute traumatic partial third-nerve palsy treated by injection of botulinum toxin A in the lateral rectus muscle showed marked recovery when injection was performed within 2 months of the onset of palsy. Botulinum toxin injection into the lateral rectus muscle may provide temporary relief of symptoms in some patients and seems to be a useful treatment option in cases of acute traumatic third nerve palsy in the short-term.
Department of Ophthalmology, Khalili Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. talebnejadmr@yahoo.com
Mohammad Reza
MR
Talebnejad
Mohammad
M
Sharifi
Mohammad Hosein
MH
Nowroozzadeh
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000150:complications*; D004334:Drug Administration Schedule; D005099:Exotropia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009801:Oculomotor Muscles / Q000187:drug effects; D015840:Oculomotor Nerve Diseases / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D020127:Recovery of Function; D019233:Retreatment; D015348:Vision, Binocular; D055815:Young Adult
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A