Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


The use of type A botulinum toxin (BTX-A) for the treatment of strabismus was for the first time proposed in the early 1980s by the American ophthalmologist Alan Scott. The earliest applications of the botulinum toxin in the clinical practice included the treatment of strabismus and blepharospasm. The use of this agent can be particularly useful in the situations where the surgical treatment of strabismus is either undesirable or impracticable for one or another reasons; moreover, injections of BTX-A were successfully used to treat the patients presenting with severe diplopia. The results of the application of the botulinum toxin reported by different authors vary considerably which dictates the necessity of a deeper insight into the mechanisms underlying its action and their further investigation. The commonest complications of therapy with this medication are a temporary ptosis and vertical deviation. The systemic complications of BTX-A application have never been documented; its repeated injections are believed to be safe for the patients.

Full Text

Restricted Access

About the authors

E. L Efimova

Saint-Petersburg State Pediatric Medical University

Saint - Petersburg, 194100, Russian Federation
cand. med. sci, associate professor of the Department of Ophthalmology, Saint-Petersburg State Pediatric Medical University, Russian Ministry of Health, Saint-Petersburg, 194100, Russian Federation


  1. Adams R.J., Hall H.L., Courage M.L. Long-term visual pathology in children with significant complications. Dev. Med. Child Neurol. 2005; 47(9): 598-602.
  2. Donnelly U.M., Stewart N.M., Hollinger M. Prevalence and outcomes of childhood visual disorders. Ophthalm. Epidemiol. 2005; 12(4): 243-50.
  3. Атаманов В.В., Черных В.В., Топорков И.А. Ботулотоксин «А» в комплексном лечении синдрома «сухого глаза» средней и тяжелой степени. Вестник Оренбургского Государственного Университета 2012; (12): 9-11.
  4. Попов В.Ю., Райкова А.С., Бржеский В.В. Современные возможности применения ботулинического токсина типа А при патологии слезных органов глаза (обзор литературы). Клиническая офтальмология. 2016; 16(2): 93-7.
  5. Scott A.B. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology. 1980; 87(10): 1044-9.
  6. Scott A.B. Botulinum toxin injection of eye muscles to correct strabismus. Trans. Am. Ophthalmol. Soc. 1981; 79: 734-70.
  7. Rowe F.J., Noonan C.P., Nayak H. Botulinum toxin as a treatment option for decompensating intermittent strabismus in children. In: Transactions of the 30th European Strabismological Association. 2005 June 8-11. Killarney, Ireland; 2005: 101-4.
  8. Molgo J. et al. Presynaptic actions of botulinal neurotoxins at vertebrate neuromuscular junctions. J. Physiol. 1990; 84: 152-66.
  9. Артемьев Д.В. Использование ботокса в медицинской практике. Неврол. журн. 2000; 5(4): 46-52.
  10. Gómez de Liaño R. Toxina botulinica. Indicaciones generales en el tratamiento de la patalogia oculomotora. In: Actualización en cirugía oftálmica pediátrica. 2000; Parte 6. Estrabismo, Capitulo 35.
  11. Gartlan M.G., Hoffman H.T. Crystalline preparition of botulinum type A (botox): Degradation in potency with storage. Otolaryngol. Head Neck Surg. 1993; 108(2): 135-40.
  12. Sampaio C., Ferreira J.J., Simoes F. et al. DYSBOT: A single-Blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A-Dysport and Botox-assuming a ratio of 4:1. Movement Disord. 1997; 12 (6): 1013-8.
  13. Jankovic J. Botuilinum toxin in movement disorders. Curr. Opin. Neurol. 1994; 7: 358-66.
  14. Campos E.C., Schiavi C., Bellusci C. Critical age of botulinum toxin treatment in essentiali infantile esotropia. J. Pediatr. Ophthtalmol. Strabismus. 2000; 37: 328-32.
  15. Minguini N. et al. Surgery with intraoperative botulinum toxin-A injection for the treatment of large-angle horizontal strabismus: a pilot study. Clinics. 2012; 67(3): 279-82.
  16. Parks M.M. Duane´s Clinical Ophthalmology. Philadelphia: JB Lippincott; 1989: Cap.1.
  17. Хирургия косоглазия / Под ред. Дж.Д. Ферриса, П.И. Дж. Дэйвиса: Пер. с англ. под научн. ред. С.Э. Аветисова, В.П. Еричева. М.: Логосфера; 2014.
  18. Paul T.O., Horn E.P., Shepherd R., Dahms G.B. Comparison of botulinum toxin injection to standard strabismus surgery in patients with horizontal strabismus. In: Presented at the Association for Research in Vision and Ophthalmology, Florida, May 5-10, 2001.
  19. McNeer K.W., Tucker M.G., Spencer R.F., Scott A.B. Botulinum toxin management of essential infantile esotropia in children. Arch. Ophthalmol. 1997; 115(11): 1411-8.
  20. Scott A.B., Magoon E.H., McNeer K.W., Stager D.R. Botulinum treatment of childhood strabismus. Ophthalmology. 1990; 97(11): 1434-8.
  21. de Albe Сampomanes A.G., Binenbaum G., Сampomanes Eguiarte G. Comparison of botulinum toxin with surgery as primary treatment for infantile esotropia. J. AAPOS. 2010; 14: 111-6.
  22. Scott A.B. Botulinum toxin treatment of strabismus. Focal points: Clinical modules for ophthalmologists. American Academy of Ophthalmology. 1989; 2: 1-11.
  23. Spencer R.F., Tucker M.G., Choi R.Y., McNeer K.W. Botulinum Toxin management of childhood intermittent extropia. Ophthalmology. 1997; 104(11): 1762-7.
  24. Razavi M.E., Sharifi M., Armanfar F. Efficacy of botulinum toxin in the treatment of intermittent exotropia. Strabismus. 2014; 22 (4): 176-81.
  25. Jones A., Jain S. Botulinum toxin: A novel treatment for pediatric cyclic esotropia. J. AAPOS. 2014; 18(6): 614-5.
  26. Khan A.O. Two horizontal rectus eye muscle surgery combined with botulinum toxin for the treatment of very large angle esotropia. A pilot study. Binocular Vision & Strabismus Qurterly. 2005; 20(1): 15-20.
  27. Owens P.L., Strominger M.B., Rubin P.A., Veronneau-Troutman S. Large-angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery. J. AAPOS. 1998; 2(3): 144-6.
  28. Ozkan S.B., Topaloglu A., Aydin S. The role of botulinum toxin A in augmentation of the effect of recession and/or resection surgery. J. AAPOS. 2006; 10(2): 124-7.
  29. Powell C., Lee J., Elston J. Role of botulinum toxin in the treatment of squint-current indications. British Orthoptic Journal. 1987; 44: 28-33.
  30. Rowe F.J., Noonan C.P., Batra R. Dose effect of botulinum toxin A in heterotropia and heterophoria. Strabismus. 2010; 18(1): 3-7.
  31. Kushner B.J. Botulinum toxin management of essential infantile esotropia in children. Arch. Ophthalmol. 1997; 115(11): 1458-9.
  32. Ing M.R. Botulinum alignment for congenital esotropia. Ophthalmology. 1993; 100(3): 318-22.
  33. Demer J.L., Clarke R.A., Lim K.H. et al. Magnetic resonance imaging evidence for widespread orbital disinnervation in dominant Duane’s retraction syndrome linked to the DURS2 locus. Invest. Ophthalmol. Vis. Sci. 2007; 48: 194-202.
  34. Demer J.L., Ortube M.C., Eagle E.C., Thacker N. High-resolution magnetic resonance imaging demonstrates abnormalities of motor nerves and extraocular muscles in patients with neuropathic strabismus. J. AAPOS. 2006; 10:135-42.
  35. Dawson E., Ali N., Lee J.P. Botulinum toxin injection in to the superior rectus for treatment of strabismus. Strabismus.2012; 20: 24-5.
  36. Farr A.K., Guyton D.L. Strabismus after retinal detachment surgery. Curr. Opin. Ophthalmol. 2000; 11: 207-10.
  37. Merino P., Munoz-Sanz N., Gómez-de-Liano P., Gutiérrez-Partida B., Seijas-Leal O. Diplopia after sub-Tenon’s anesthesia for cataract surgery. Arch. Soc. Esp. Oftalmol. 2006; 81: 141-6.
  38. Merino P.S., Vera R.E., Marinas L.G., Gomes de Liano P.S., Estribano J.V. Botulinum toxin for treatment of restrictive strabismus. J. Optom. 2016,
  39. Lyons C.J., Vickers S.F., Lee J.P. Botulinum toxin therapy in dysthyroid strabismus. Eye. 1990; 4: 538-42.
  40. Metz H.S., Mazow M. Botulinum toxin treatment of acute sixth and third nerve palsy. Graefes Arch. Clin. Exp. Ophthalmol. 1988; 226(2): 141-4.
  41. Gómez de Liaño P. Parálisis oculomotora infantile. In: Actualización en cirugía oftálmica pediátrica. 2000; Parte 6. Estrabismo, Capitulo 46.
  42. Schumacher-Feero L.A., Yoo K.W., Solari F.M. et al. Third cranial nerve palsy in children. Am. J. Ophthalmol. 1999; 128(2): 216-21.
  43. Scott A.B. Botulinum toxin therapy of eye muscle disorders. Safety and effectiveness. Ophtalmic procedures assessment recommendations. American Academy of Ophthalmology. 1989; 2: 37-41.
  44. Frueh B.R., Henderson J.W. Rectus muscle union in sixth nerve paralysis. Arch. Ophthalmol. 1971; 85:191-6.
  45. Ziylan S., Yabas O., Karsioglu S. Botulinum toxin for acute sixth nerve palsy or paresis. In: Meeting of the European Strabismological Association, 30th: Final Programme and Abstracts. Killarney, Ireland: Co. Kerry; 2005: 86.
  46. Holmes J.M., Beck R.W., Kip K.E. et al. Predictors of nonrecovery in acute traumatic sixth nerve palsy and paresis. Ophthalmology. 2001; 108(8): 1457-60.
  47. Holmes J.M., Leske D.A. Long-term outcomes after surgical management of chronic sixth nerve palsy. J. AAPOS. 2002; 6(5): 283-8.
  48. Repka M.X., Lam G.C., Morrison N.A. The efficacy of botulinum neurotoxin A for the treatment of complete and partially recovered chronic sixth nerve palsy. J. Pediatr. Ophthalmol. Strabismus. 1994; 31(2): 79-83.
  49. Plisov I.L., Batalova O.M., Puzyrevsky K.G., Atamanov V.V. An efficacy of chemodenervation for the treatment of chronic sixth nerve palsy. In: Meeting of the European Strabismological Association, 31st: Final Programme and Abstracts. Mykonos, Greece; 2007: 57.
  50. Lee J., Elston J., Vickers S. et al. Botulinum toxin therapy for squint. Eye. 1988; 2: 24-8.
  51. Rowe F.J., Noonan C.P. Botulinum toxin for the treatment of strabismus. Cochrane Database Syst. Rev. 2012; (2): Art. No. CD006499. doi: 10.1002/14651858. CD006499.pub2.
  52. Ripley L., Rowe F.J. Use of botulinum toxin in small angle heterotropia and decompensating heterophoria: Review of the literature. Strabismus. 2007; 15: 165-71.
  53. Biglan A., Burnstine R., Rogers G., Saunders R. Management of strabismus with botulinum A toxin. Ophthalmology. 1989; 96: 935-43.
  54. Abbasoglu E., Sener E., Sanac A. Factors influencing success and dose effect relation of botulinum A treatment. Eye. 1996; 10: 385-91.
  55. Sener E., Sanac A. Efficacy and complications of dose increments of botulinum toxin-A in the treatment of horizontal comitant strabismus. Eye. 2000; 14: 873-8.
  56. Magoon E., Scott A. Botulinum toxin chemo-denervation in infants and children: an alternative to incisional strabismus surgery. J. Pediatr. Ophthalmol. Strabismus. 1987; 110: 719-22.
  57. Flores-Reyes E.M. et al. Uso de toxina botulinica A en el tratamiento de las endotropías parcialmente acomodativas. Arch. Soc. Esp Oftalmol. 2016; 91(3): 120-4.
  58. Rowe F.J., Noonan C.P. Complications of Botulinum Toxin A and Their Adverse Effects. Strabismus. 2009; 17(4): 139-42.
  59. Horgan S, Lee J, Bunce C. The long term use of botulinum toxin for adult strabismus. J Pediatr Ophthalmol Strabismus. 1998; 35: 9-16.



Abstract - 100

PDF (Russian) - 0


Article Metrics

Metrics Loading ...


  • There are currently no refbacks.

Copyright (c) 2017 Eco-Vector

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies