Result of Initial Botulinum Toxin Injection in Childhood Horizontal Strabismus

Roh, Young Bae; Choi, Young Rak

Abstract

Thirty one children with horizontal strabismus in age less than 10 years were treated with botulinum toxin type A(Botox) injection of extraocular muscles. We have analyzed the effects and complications of injection in twenty five patients for whom follow-up of 3 months or more was available. Preinjection alignment was 25+/-11 prism diopter(PD) in exotropia and 35+/-10PD in esotropia. The average time of maximal effect was 1 week after injection and the average time to achieve orthotropia 2 to 3 months after injection. At three months after injection, the alignments in fifteen patients(60%) were 10 prism diopter(PD) or less, in eight between 10 and 20PD, and in two more than 20PD. Success rate was high when limitation of eye movement was obvious(> OR = -2) at 1 week after injection. The most common complications were ptosis presented in fifteen patients(60%), subconjucntival hemorrhage in eight, abnormal head position in seven, vertical strabismus in seven and disorientation in one. Initial injection of botulinum toxin showed poorer results compared to surgery in childhood horizontal strabismus but did not show severe complications except undercorrection. Toxin injection can be an alternative choice of strabismus management but more prolonged follow-up will be needed.