Pharmacological denervation in the treatment of sixth cranial nerve palsy

Fifteen adults, with acute or chronic sixth cranial nerve palsy, had BTXA injections in the medial rectus of the affected eye to prevent its contracture. Follow up after last injection was 12-24 months. Treatment was considered successful if at 12 months after last injection the patient recovered, even partially, binocular vision and the reduction of the angle of the primary deviation was stable. There were no local or sistemic side effects. 11 patients (73%) had final alignement within 0 and +10 PD and achieved stereopsis and fusion. Chemodenervation can be considered as a primary therapy before performing surgical treatment that is more invasive.