Document Detail

Botulinum toxin management of childhood intermittent exotropia.
MedLine Citation:
PMID:  9373104     Owner:  NLM     Status:  MEDLINE    
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.
R F Spencer; M G Tucker; R Y Choi; K W McNeer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Ophthalmology     Volume:  104     ISSN:  0161-6420     ISO Abbreviation:  Ophthalmology     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1997-11-28     Completed Date:  1997-11-28     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1762-7     Citation Subset:  IM    
Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0146, USA.
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MeSH Terms
Anesthesia, Inhalation
Anti-Dyskinesia Agents / therapeutic use*
Botulinum Toxins / therapeutic use*
Case-Control Studies
Child, Preschool
Exotropia / drug therapy*
Oculomotor Muscles / drug effects*
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Anti-Dyskinesia Agents; 0/Botulinum Toxins
Comment In:
Ophthalmology. 1999 Jun;106(6):1045-6   [PMID:  10366068 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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