Botulinum toxin management of childhood intermittent exotropia.

Abstract

OBJECTIVE:

Intermittent exotropia is a common form of childhood strabismus that has a late onset and presents a difficult and frustrating management dilemma. Surgical treatments have a high recurrence rate, and multiple surgeries often are required to achieve a desirable motor outcome. This study presents long-term observations on the use of botulinum toxin for the treatment of intermittent exotropia in children.

DESIGN:

This study is a nonrandomized, case-controlled study of consecutive pediatric patients who had intermittent exotropia.

PARTICIPANTS:

Thirty-two neurologically normal children ranging from 3 to 144 months in age were diagnosed with intermittent exotropia with a minimum distance deviation of 15 prism diopters (PD).

INTERVENTION:

Simultaneous bilateral injections of 2.5 units botulinum toxin type A were made into the lateral rectus muscles with the patient receiving nitrous oxide-ethrane inhalation anesthesia. Patients were observed for 12 to 44 months after the initial injection.

MAIN OUTCOME MEASURES:

A satisfactory outcome was considered to be stable binocular alignment of the eyes to an orthophoric range of +/-10 PD.

RESULTS:

Bilateral lateral rectus muscle injections of botulinum toxin were effective in reducing the mean preinjection deviation of -29 PD to an average exotropic angle of -6 PD. Stable orthophoria (+/-10 PD) was achieved in 22 patients (69%). Overall, male patients required significantly fewer injections than did female patients. All patients between 24 and 56 months of age, irrespective of gender, required only a single bilateral injection to achieve a favorable motor outcome.

CONCLUSIONS:

Botulinum toxin is at least as effective as surgical outcomes reported previously for the treatment of intermittent exotropia in children. This treatment method is particularly effective in children between 2 and 4.5 years of age irrespective of the initial strabismic angle and is not associated with any secondary abnormalities.

• Authors: R F Spencer, M G Tucker, R Y Choi, K W McNeer
• Journal: Ophthalmology (Ophthalmology) Vol. 104 Issue 11 Pg. 1762-7 (Nov 1997) ISSN: 0161-6420 [Print] United States
• PMID: 9373104 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-Dyskinesia Agents
• Botulinum Toxins

Topics

• Anesthesia, Inhalation
• Anti-Dyskinesia Agents (therapeutic use)
• Botulinum Toxins (therapeutic use)
• Case-Control Studies
• Child
• Child, Preschool
• Exotropia (drug therapy)
• Female
• Humans
• Infant
• Injections
• Male
• Oculomotor Muscles (drug effects)
• Treatment Outcome