title: Chemodenervation of extraocular muscles with botulinum toxin in thyroid eye disease.
abstract: BACKGROUND
  Thyroid eye disease (TED) presents a management dilemma for strabismologists due to the variability of its clinical course. Prisms may be prescribed to relieve diplopia in small deviations. Surgical intervention, on the other hand, should not be done until the active phase of the disease has subsided. We report our experience with chemodenervation utilizing botulinum toxin (BT) injection in the management of TED-related strabismus.
  
  
  METHODS
  A retrospective chart review was done on twenty-two (22) consecutive patients receiving BT injections at the University of California, San Diego (UCSD) Thyroid Eye Center. All BT injections were administered by a single physician under electromyographic guidance.
  
  
  RESULTS
  The clinical records of 22 patients (18 females) were reviewed. Seven patients (32 %) had a reduction of their deviation to a point where surgery was not required. In six patients (27 %), surgery was required but an improvement in ocular deviation was found, altering the original surgical plan. In four patients (18 %), the deviation continued to progress after BT injection. Success rates were higher if pre-treatment deviation was less than 20 prism diopters ((∆)).
  
  
  CONCLUSIONS
  One third of the chemodenervation-treated patients avoided surgical intervention, with an additional 27 % (total of 40 % of those who needed surgery) having a reduced deviation prior to surgery. Using BT injection to extraocular muscles to treat diplopia in TED patients is most effective in preventing surgery in those patients with 20(∆) or less of deviation.
authors: Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA. dgranet@ucsd.edu.
authors: David B
authors: DB
authors: Granet
authors: Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA.
authors: Nickisa
authors: N
authors: Hodgson
authors: Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA.
authors: Kyle J
authors: KJ
authors: Godfrey
authors: Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA.
authors: Ricardo
authors: R
authors: Ventura
authors: Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA.
authors: Don O
authors: DO
authors: Kikkawa
authors: Division of Ophthalmology, Scripps Clinic, La Jolla, CA, USA.
authors: Leah
authors: L
authors: Levi
authors: Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA.
authors: Michael
authors: M
authors: Kinori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A; D004576:Electromyography; D005260:Female; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009801:Oculomotor Muscles / Q000294:innervation*; D012189:Retrospective Studies; D013285:Strabismus / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Restrictive strabismus; Strabismus surgery; Thyroid eye disease