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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
Rosenbaum AL. The Current Use of Botulinum Toxin Therapy in Strabismus. Arch Ophthalmol. 1996;114(2):213-214. doi:10.1001/archopht.1996.01100130207019