Botulinum toxin injection to the lateral rectus for the treatment of intractable diplopia

The aim of the study is to evaluate the use of botuline A (BTXA) as a form of treatment for squinting patients with onerous diplopia. Two patients with exotropia and one patient with esotropia had injections of BTX A to the lateral rectus muscles of the affected side. The number of injections ranged from 1 to 2. Two patients went on to have surgery. All patients in our study found that BTX A improved their symptoms of diplopia. We conclude that BTX A has an important role in the treatment of squinting patients with burdensome diplopia.     

Botulinum toxin for the treatment of congenital entropion

Purpose

To describe a case of congenital entropion presenting with ulcerative keratitis that was successfully treated with a single injection of botulinum toxin.

Design

Interventional case report.

Methods

A 3-week-old female infant with a corneal ulcer of the left eye since birth presented for evaluation. She was found to have entropion of the left lower lid. The pretarsal orbicularis muscle was injected with 5 units of botulinum toxin.

Results

Four days after treatment, the entropion had resolved and the corneal epithelial defect had healed. There was no recurrence of the entropion 7 months after botulinum toxin injection.

Conclusions

Injection of botulinum toxin can effectively treat certain cases of congenital entropion.     

Botulinum toxin as novel treatment for excess mucous membrane graft secretions

Salivary gland secretion is an unusual complication of mucous membrane grafting. The authors report a case in which botulinum toxin was successfully used to treat graft secretions after buccal mucous membrane autograft for recurrent pterygium repair.     

Botulinum toxin type a for dysthyroid upper eyelid retraction

PURPOSE: To evaluate the safety and efficacy of botulinum toxin type A for treatment of eyelid retraction resulting from thyroid eye disease (TED) during the inflammatory phase of the condition. METHODS: In this prospective, nonrandomized case series, 18 patients with inflammatory eyelid retraction caused by active TED received botulinum toxin type A injection (10, 5, or 2.5 U) for treatment of upper eyelid retraction. Botulinum toxin type A (Allergan, Irvine, CA, U.S.A.) was injected transconjunctivally just above the superior tarsal border in the elevator complex of the upper eyelid. RESULTS: Seventeen of 18 patients (94%) demonstrated a reduced marginal reflex distance (MRD1) after botulinum toxin injection. The average change in MRD1 of the treated eyelid after injection was -2.35 mm (range, 0 to -8.0 mm). Of the 27 eyelids injected, 33% had a 0- to 1-mm drop in eyelid height, 30% had a 1.5- to 2-mm decrease, 22% had a 2.5- to 3-mm decrease, and 15% had a greater than 3-mm decrease in eyelid height. None of the treated eyelids were noted to increase in height. One patient showed no alteration inafter treatment. One patient had clinically MRD1 significant ptosis and one patient reported worsening of preexisting diplopia after injection. Three patients undergoing unilateral injection had relative contralateral eyelid elevation. All untoward effects resolved spontaneously without sequelae. CONCLUSIONS:: Botulinum toxin type A may be used in the inflammatory stage of thyroid eye disease to improve upper eyelid retraction. Individual response to treatment is variable, but this modality should be considered as a temporizing measure until stability for surgery is reached.     

Botulinum toxin as adjunct for refractory compressive optic neuropathy in Graves' disease

An euthyroid patient was referred for compressive optic neuropathy in Graves' disease. Under prednisone therapy the right and left visual acuities were 1.0 and 0.4, with a profound decrease in color vision on the left. Bilateral anterior orbital decompressions were performed. When prednisone was withdrawn postoperatively, the visual acuity of the right eye dropped to 0.32 with bilateral complete failure on the Ishihara color test. A biopsy of the inferior oblique muscle of the left eye confirmed Graves' disease and additional transantral decompression of the right orbital apex was performed. Under intravenous methylprednisolone therapy, the visual acuity dropped postoperatively to 0.2 and 0.4, respectively. 15 U botulinum toxin were given by retrobulbar injection between the inferior and lateral rectus muscles. Four days later the patient called and said that the visual acuity in the right eye had improved tremendously. Two weeks after the injection the visual acuity was 0.7 in both eyes, although prednisone had been reduced to 20 mg by that time. The convergent strabismus had increased but the already severely restricted motility of the right eye had been little affected by the retrobulbar injection, and adduction not at all. Orbital CT-scan showed thinning of the inferior and lateral rectus muscles, but not of the medial rectus.     

Botulinum toxin as adjunct for refractory compressive optic neuropathy in Graves' disease

An euthyroid patient was referred for compressive optic neuropathy in Graves' disease. Under prednisone therapy the right and left visual acuities were 1.0 and 0.4, with a profound decrease in color vision on the left. Bilateral anterior orbital decompressions were performed. When prednisone was withdrawn postoperatively, the visual acuity of the right eye dropped to 0.32 with bilateral complete failure on the Ishihara color test. A biopsy of the inferior oblique muscle of the left eye confirmed Graves' disease and additional transantral decompression of the right orbital apex was performed. Under intravenous methylprednisolone therapy, the visual acuity dropped postoperatively to 0.2 and 0.4, respectively. 15 U botulinum toxin were given by retrobulbar injection between the inferior and lateral rectus muscles. Four days later the patient called and said that the visual acuity in the right eye had improved tremendously. Two weeks after the injection the visual acuity was 0.7 in both eyes, although prednisone had been reduced to 20 mg by that time. The convergent strabismus had increased but the already severely restricted motility of the right eye had been little affected by the retrobulbar injection, and adduction not at all. Orbital CT-scan showed thinning of the inferior and lateral rectus muscles, but not of the medial rectus.     

肉毒杆菌毒素A治疗婴幼儿型内斜视的新进展

肉毒杆菌毒素由于具有可逆性、副作用小、临床使用操作简便等优点，在多种类型的斜视、眼睑痉挛、上睑退缩等疾病治疗方面的研究日益深入。近年来，肉毒杆菌毒素A注射眼外肌治疗婴幼儿型内斜视，不仅比手术治疗方法简便，而且将治疗时间提前，为患儿早期视功能的建立提供了新的思路和方法，本文就此方面的临床研究和应用作一综述。     

Botulinum toxin for the treatment of dysthyroid ocular myopathy

Eight consecutive patients with acquired deviations due to dysthyroid ocular myopathy were injected with botulinum A toxin for relief of their diplopia. Seven patients were acute in the onset of symptoms and one was chronic. All showed improvement in motility and experienced a reduction if not total relief of their symptoms. Six patients required reinjection. Complications were limited to transient ptosis, transient involvement of adjacent muscles and transient but prolonged paralysis that eventually resolved. No systemic complications were noted. We conclude that chemodenervation with botulinum A toxin may have a role in the management of dysthyroid ocular myopathy not amenable to prism treatment and may act as an adjunct to or eliminate the need for surgical correction in some patients.     

Botulinum toxin for lower lid entropion correction

This prospective clinical study was designed to evaluate the efficacy of botulinum toxin for temporary treatment of senile and congenital lower lid entropion. Seventeen patients with senile entropion and three children with congenital entropion were treated with botulinum toxin injection into the preseptal orbicularis muscle of lower lid. This resulted in transient relieve of the condition, which lasted for a period of 8-26 weeks. This technique is easy and effective for senile entropion as well as certain cases of congenital entropion.     

眼眶下壁骨折术后长期复视原因分析

目的 分析眼眶骨折手术失败的原因.方法 眼眶下壁骨折术后长期复视12例临床资料进行回顾性研究.结果 12例眶下壁骨折主要表现为垂直复视及眼球内陷.均行手术治疗.术后表现为复视加重并长期不缓解;术后计算机断层成像(CT)显示其中9例存在骨折后缘分离不彻底,存在医源性嵌顿;2例楔形眶底材料使用者植入材料位置靠前,造成眼球上移位;1例儿童骨折存在术后再粘连及肌腹上抬现象.结论 手术中彻底的分离并还纳眶内组织,正确的植入位置及防粘连措施是眼眶骨折手术成功的重要因素.     

Botulinum toxin injection into the superior rectus for treatment of strabismus

Botulinum toxin injected into the superior rectus (SR) has rarely been described in the literature. We conducted a database search to identify all cases of SR toxin from 1982 to 2010 at our institution. Out of a total of 7575 patients in the database, only eight cases of SR toxin were identified, all of which had residual hypertropia following previous ocular surgery. This surgery comprised: retinal surgery (3 patients), strabismus surgery for thyroid eye disease (2), and transposition for VI nerve palsy (2 patients). In seven out of eight cases, a long-lasting mean reduction of 10(Δ) was achieved from between two and three injections. Ptosis occurred in all but one case, but resolved. We conclude that SR toxin injection has very limited indications, but may be considered in residual hypertropia presumed secondary to a tight or overacting SR where the patient can tolerate the temporary iatrogenic ptosis.