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  • Title: [Value of delayed botulinum toxin injection in esotropia in the child as first line treatment].
    Author: Robert PY, Jeaneau-Bellego E, Bertin P, Adenis JP.
    Journal: J Fr Ophtalmol; 1998; 21(7):508-14. PubMed ID: 9805686.
    Abstract:
    PURPOSE: Evaluation of botulinum toxin to treat esotropia in children over 3 years old. MATERIAL AND METHODS: Eight children (6 boys and 2 girls), aged from 3 to 6 years (mean 4), underwent bilateral injection of 1.25 UI botulinum toxin Botox in medial rectus muscles, under general anesthesia. Preoperative diagnosis was infantile esotropia in 7 cases, and decompensated esophoria in 1 case. Six children had alternating isoacuity before injection, and two had amblyopia. Mean follow-up was 1.8 months (6 to 24 months). RESULTS: One transient exotropia, and one transient ptosis were reported. Lasting orthotropia was achieved in four children (including one who presented again spasms in near vision), and lasting angle reduction in another child. Another child had late recurrence at 18 months. The injection was a failure for the two amblyopic children. DISCUSSION: Botulinum therapy allowed to avoid surgery in three cases, and to perform a more limited operation in one case. CONCLUSION: Botulinum toxin injection in extraocular muscles is of interest in infantile esotropia as a first treatment, even in children over 3 years. The success relies principally on the absence of deep amblyopia, and muscular elongation troubles. However, the use of botulinum is limited, because it requires general anesthesia, and because of its price.
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