title: Botulinum toxin for treatment of restrictive strabismus.
abstract: OBJECTIVE
  To study the types of acquired restrictive strabismus treated in a tertiary hospital and the outcome of treatment with botulinum toxin.
  
  
  METHODS
  We performed a 10-year retrospective study of patients with restrictive strabismus aged ≥18 years who were treated with botulinum toxin. Treatment was considered successful if the final vertical deviation was ≤5 PD, horizontal deviation ≤10 PD, with no head turn or diplopia.
  
  
  RESULTS
  We included 27 cases (mean age, 61.9 years). Horizontal strabismus was diagnosed in 11.1%, vertical in 51.9%, and mixed in 37%. Strabismus was secondary to cataract surgery in 6 cases, high myopia in 6, orbital fractures in 5, retinal surgery in 5, Graves ophthalmopathy in 4, and repair of conjunctival injury in 1 case. Diplopia was diagnosed in all patients, head turn in 33.3%. The initial deviation was 14 PD (range, 2-40), the mean number of injections per patient was 1.6 (range, 1-3), and the mean dose was 9.5 IU (range, 2.5-22.5). At the end of follow-up, diplopia was recorded in 59.3%, head turn in 18.5%, surgical treatment in 51.9%, and need for prism glasses in 14.8%. Outcome was successful in 37% of patients (4 high myopia, 3 orbital fractures, 2 post-surgical retinal detachment, and 1 post-cataract surgery). Mean follow-up was 3±1.8 years.
  
  
  CONCLUSIONS
  Vertical deviation was observed in half of the sample. The most frequent deviation was secondary to cataract surgery and high myopia. Treatment with botulinum toxin was successful in one-third of the patients at the end of follow-up.
authors: Ocular Motility Section, Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: pilimerino@gmail.com.
authors: Pilar S
authors: PS
authors: Merino
authors: Ocular Motility Section, Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Rebeca E
authors: RE
authors: Vera
authors: Ocular Motility Section, Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Laura G
authors: LG
authors: Mariñas
authors: Ocular Motility Section, Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Pilar S
authors: PS
authors: Gómez de Liaño
authors: Ocular Motility Section, Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Jose V
authors: JV
authors: Escribano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001905:Botulinum Toxins / Q000008:administration & dosage*; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000008:administration & dosage; D009801:Oculomotor Muscles; D012189:Retrospective Studies; D013285:Strabismus / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins
keywords: Acquired restrictive strabismus; Botulinum toxin; Estrabismo miópico adquirido; Estrabismo restrictivo adquirido; Estrabismo secundario a cirugía de cataratas; Graves ophthalmopathy; Myopic acquired strabismus; Oftalmopatía de Graves; Strabismus secondary to cataract surgery; Toxina botulínica