Botulinum Toxin for Strabismus Treatment

Summary

The bacterial species Clostridium botulinum produces a class of neurotoxins known as botulinum toxin. At the neuromuscular junction, botulinum toxin A prevents acetylcholine from being released. Following a Botox intramuscular injection, the injected EOM becomes paralysed 2-4 days after the injection and remains so clinically for at least 5-8 weeks. Muscle function recovery takes five to fourteen weeks, depending on the injection site, volume, and concentration of the solution, as well as the innervation density. Botulinum toxin treatment results in a pharmacologic recession of the injected extraocular muscle, and the muscle lengthens while its agonist contracts, paralysing it. Improved ocular alignment or a decrease in the severity of the deviation may last for a long time, even if the pharmaceutical impact normally goes away after three months. Even after the pharmacologic effect has worn off, a number of elements, such as mechanical, proprioceptive, and binocular effects, may intervene during the period of muscle paralysis to help stabilise and improve alignment in strabismus patients over the long term.

Timeline

Start

2025-09-30

Primary completion

2030-08-30

Completion

2030-08-30

Publications

• Background Badakere A, Badrinath V, Dhillon HK, Valliappan A, Natarajan V, Agarkar S. Botulinum toxin A as a treatment modality for acute acquired comitant esotropia - An Indian perspective. Indian J Ophthalmol. 2025 Feb 1;73(2):228-230. doi: 10.4103/IJO.IJO_2198_23. Epub 2024 Aug 14.
• Background Scott AB, Fahn S, Brin MF. Treatment of strabismus and blepharospasm with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore). 2023 Jul 1;102(S1):e32374. doi: 10.1097/MD.0000000000032374.
• Background Bort-Marti AR, Rowe FJ, Ruiz Sifre L, Ng SM, Bort-Marti S, Ruiz Garcia V. Botulinum toxin for the treatment of strabismus. Cochrane Database Syst Rev. 2023 Mar 14;3(3):CD006499. doi: 10.1002/14651858.CD006499.pub5.

Drugs

Indications