title: Role of inferior rectus botulinum toxin injection in iatrogenic vertical strabismus.
abstract: BACKGROUND
  We describe the uses and effectiveness of botulinum toxin to the inferior rectus muscle in iatrogenic vertical strabismus.
  
  
  METHODS
  A retrospective review of our database to identify patients who had undergone inferior rectus botulinum toxin injection between 1982 and 2006 for iatrogenic vertical strabismus.
  
  
  RESULTS
  There were 13 patients, 5 female, with an age range of 14 to 78 years. Eight left eyes were injected. The mean period of follow-up was 3.3 years. Etiologies included post-local anesthetic, post-plaque radiotherapy for malignant melanoma, adherence syndrome after inferior oblique surgery, and post-botulinum toxin to the levator muscle to produce a temporary therapeutic ptosis. Reversal on first injection occurred in 7 patients and occurred in a further 2 patients on second injection. Pre-injection binocularity was not demonstrable in 3 patients; 2 of these patients did have binocular vision demonstrable after botulinum toxin injection. Seven patients had one injection, 3 patients had two, 1 had three, 1 had five, and 1 had six.
  
  
  CONCLUSIONS
  The data demonstrate the range of indications that can be successfully treated and managed with inferior rectus botulinum toxin injection in iatrogenic vertical strabismus.
authors.affiliation: Moorfields Eye Hospital, London. johnsbarry@doctors.org.uk
authors.forename: John-Sebastian
authors.initials: JS
authors.lastname: Barry
authors.forename: Emma L M
authors.initials: EL
authors.lastname: Dawson
authors.forename: Gillian G W
authors.initials: GG
authors.lastname: Adams
authors.forename: John P
authors.initials: JP
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D001918:Brachytherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000187:drug effects* / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D013285:Strabismus / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins