Non-Surgical Treatment of Strabismus with Botox

Strabismus is an eye disease that causes the eyes to point in different directions inappropriately. There are different treatment methods for this disease. One of the most effective methods is non-surgical treatment with botulinum toxin (botox).

Contrary to popular belief, the first use of Botox in the medical field was not for cosmetic purposes, but for the treatment of strabismus patients. Ophthalmologists were the first doctors to apply botulinum toxin treatment.

How Does Botox Treat Strabismus?

Botox is a neurotoxin produced by the bacterium Clostridium botulinum. Botox paralyzes the muscle by affecting the nerve endings that activate the muscles. Its effect lasts for 6 months. Although it causes temporary paralysis, permanent changes in the structure and function of the muscles occur during this period, thus reducing strabismus.

How is strabismus treatment performed with Botox?

Anesthesia in children is performed with sedoanalgesia applied by a doctor. Sedoanalgesia is a less risky method than general anesthesia used in surgery. Botox treatment can be applied under sedoanalgesia to children who are at risk of receiving general anesthesia. In adults, numbing eye drops are used. Botox application takes about 5 minutes. Botox is applied to the location of the muscle with an EMG device that does not damage tissues and blood vessels. The most important advantages of Botox injections are that they can be repeated and do not affect the patient's chances of surgical treatment.

Key Benefits of Botox Strabismus Treatment

 It can be applied to adult patients on an outpatient basis without the need for general anesthesia.

 Ability to resume normal life after application

 There is no risk of general anesthesia

 Botox injection can be repeated

 There is no upper limit to the number of Botox injections

 Does not leave a mark

 Botox is temporarily effective

 It does not affect the patient's chances of surgical treatment.

In What Cases Is Botox Treatment Used?

Botox treatment is a modern treatment for strabismus caused by muscle paralysis. In cases of sudden strabismus due to paralysis of the extraocular muscles, it is necessary to wait 6-8 months for surgical treatment. Because this type of strabismus has the possibility of self-correction. Nevertheless, in these patients, double vision is usually accompanied by strabismus, and this condition is difficult for the patient to tolerate. During the waiting period, botox treatment is used to eliminate double vision.

In strabismus caused by nerve palsy, especially in cases of 6th nerve palsy and 3rd (oculomotor) nerve palsy, we apply botulinum toxin treatment to our patients to reduce eye mismatch and control double vision.

In cases of congenital strabismus, botok treatment is also applied to children who cannot receive anesthesia due to the risk.

Botox can also be applied to patients who have not achieved complete recovery after strabismus surgery.

How Long Does Botulinum Toxin Treatment Last?

Botulinum toxin generally lasts up to 6 months. If an eye misalignment occurs due to paralysis and we can predict that this paralysis will improve within 6 months, we can make these 6 months more comfortable for the patient with botulinum toxin treatment. By doing so, we can prevent permanent strabismus that may occur.

Clinical trials using botulinum toxin have shown it to be more effective in the following conditions:

Esotropia or exotropia (<40 PD) with small to moderate angular deviation;

Acute onset esotropia;

Postoperative residual or persistent strabismus (2-8 weeks or more after surgery);

Acute paralytic to relieve diplopia during paralysis; strabismus (mainly sixth nerve palsy, sometimes fourth nerve palsy);

Active thyroid eye disease (Graves disease), inflamed or pre-phthisis eyes, in cases where surgery is not recommended;

Adjunct to surgery for large-angle esotropia or sixth nerve palsy or wide-angle exotropia;

As a muscle-sparing option in patients at risk of anterior segment ischemia