title: Tonic pupil after botulinum toxin-A injection for treatment of esotropia in children.
abstract: A total of 27 children with esotropia (mean age, 3.9 years; range, 9 months to 13.8 years) were enrolled in a 9-month observational study following botulinum toxin A (BTX-A) injection of one (n = 7) or both (n = 20) medial rectus muscles. BTX-A dosage ranged from 3.0 to 6.0 units per muscle. Three participants developed tonic pupil, noted at the first follow-up visit, occurring 12-19 days after injection. All 3 cases occurred in the left eye of participants who underwent bilateral BTX-A injection by the same surgeon. Anisocoria diminished from a maximum of 4 mm at the 2-week visit to 1-2 mm in all patients over the 9-month postinjection data collection period. No adverse visual outcomes were noted. Tonic pupil is an infrequently reported complication of BTX-A injection for strabismus. The experience of our investigator group suggests the need for careful injection technique and thorough preinjection counseling.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Christiansen
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Chandler
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Lee
authors.forename: Rosanne
authors.initials: R
authors.lastname: Superstein
authors.forename: Alejandra
authors.initials: A
authors.lastname: de Alba Campomanes
authors.forename: Erick D
authors.initials: ED
authors.lastname: Bothun
authors.forename: Julie
authors.initials: J
authors.lastname: Morin
authors.forename: David K
authors.initials: DK
authors.lastname: Wallace
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Kraker
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000009:adverse effects*; D009801:Oculomotor Muscles / Q000187:drug effects; D010865:Pilot Projects; D015845:Tonic Pupil / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A