Botulinum toxin in the treatment of paralytic strabismus

In oculomotor palsies botulinum toxin A injections into extraocular muscles under electromyographic control represents a most efficient method, especially in the initial stages, to obviate disturbing and diplopia producing overaction resp. contracture of the homolateral antagonist of the paretic or paralyzed muscle or muscles. It seems that with such toxin injections into the antagonist the recovery of the paralyzed agonist proceeds better and quicker. Most important in many cases is the resulting rapid restoration of binocular sensory function which avoids later decompensation of the oculomotor balance and eventual necessity of secondary muscle surgery. In cases of non-recovering oculomotor palsies the toxin injections into the ipsilateral antagonist represent an important adjunct to surgical intervention on the paralyzed agonist: most often a a recession procedure on the overacting antagonist is no longer necessary or only with a much smaller amount than usual. Botulinum toxin A injections turn out to be especially helpful in fresh cases of sixth and fourth nerve palsies and should be applied as early as possible in order to prevent the development of contractures and to restore binocular single vision rapidly.