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February 1996

The Current Use of Botulinum Toxin Therapy in Strabismus

Author Affiliations

Los Angeles, Calif

Arch Ophthalmol. 1996;114(2):213-214. doi:10.1001/archopht.1996.01100130207019

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The use of botulinum toxin as a therapeutic alternative in strabismus was first reported in a primate model in 1973.1 These experiments demonstrated that a localized injection to a specific extraocular muscle could achieve a prolonged paralysis of that muscle without inducing unwanted side effects. The degree of paralysis and duration of its effect could be controlled by dose. Human studies were started in the United States in 1977 under Food and Drug Administration (FDA) supervision. In December 1989, the FDA approved botulinum toxin for use in adults and children over 12 years of age with strabismus. Since then, it has been used in a variety of strabismic conditions, with varying degrees of enthusiasm. The purpose of this Editorial is to clarify the strabismic situations in which this drug may be the most helpful.

Botulinum neurotoxin acts selectively on peripheral cholinergic nerve endings to inhibit acetylcholine release.2 The

Scott AB, Rosenbaum AL, Collins CC.  Pharmacologic weakening of extraocular muscles . Invest Ophthalmol Vis Sci . 1973;12:924-927.
Coffield JA, Considine RV, Simpson LL.  The site and mechanism of action of botulinum neurotoxin . In: Jankovic J, Hallett M, eds. Therapy With Botulinum Toxin . New York, NY: Marcel Dekker Inc; 1994:3-14.
Scott AB.  Change of eye muscle sarcomeres according to eye position . J Pediatr Ophthalmol Strabismus . 1994;31:85-88.
Metz HS, Mazow ML.  Botulinum toxin: treatment of acute VI and III nerve palsies . Graefes Arch Clin Exp Ophthalmol . 1988;226:141-144.Article
Lee JP.  Modern management of VI nerve palsy . Aust N Z J Ophthalmol . 1990;20:41-46.Article
Rosenbaum AL, Kushner BJ, Kirschen DL.  Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy . Arch Ophthalmol . 1989;107:820-823.Article