title: Botulinum Toxin as an Alternative to Treat the Spasm of the Near Reflex.
abstract: We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex.
authors.affiliation: a Department of Ophthalmology , Oftalmar, Medimar International Hospital , Alicante , Spain .|b Foundation for Visual Quality (FUNCAVIS) , Alicante , Spain .
authors.forename: Carlos
authors.initials: C
authors.lastname: Laria
authors.affiliation: c Hospital Marina Baixa, Villajoyosa , Alicante , Spain , and.
authors.forename: María L
authors.initials: ML
authors.lastname: Merino-Suárez
authors.affiliation: a Department of Ophthalmology , Oftalmar, Medimar International Hospital , Alicante , Spain .|b Foundation for Visual Quality (FUNCAVIS) , Alicante , Spain .|d Department of Optics , Pharmacology and Anatomy, University of Alicante , Alicante , Spain.
authors.forename: David P
authors.initials: DP
authors.lastname: Piñero
authors.affiliation: c Hospital Marina Baixa, Villajoyosa , Alicante , Spain , and.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Gómez-Hurtado
authors.affiliation: a Department of Ophthalmology , Oftalmar, Medimar International Hospital , Alicante , Spain .|b Foundation for Visual Quality (FUNCAVIS) , Alicante , Spain .
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Pérez-Cambrodí
mesh_terms: D000065:Accommodation, Ocular / Q000187:drug effects* / Q000502:physiology; D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D004948:Esotropia / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D009801:Oculomotor Muscles / Q000187:drug effects*; D012021:Reflex, Abnormal / Q000187:drug effects*
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Accommodative spasm; botulinum toxin; esotropia; near reflex