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Treatment of heterophoria with botulinum toxin A — a case study
, 2
Affiliations- Student Research Group at the Clinic and Department of General and Children's Ophthalmology of the Medical University of Lublin, Lublin, Poland
- OCHO — Eye Surgery Center, Nałęczów, Poland
open access
Abstract
Background: Heterophoria (latent strabismus) is an imbalance in the tone of the oculomotor muscles. In a young child, this disorder usually does not affect the development of binocular vision. While looking, binocular vision (image fusion) keeps the eyeballs straight. With age, binocular vision may be impaired, for example, as a result of trauma, general disease, stress, or severe fatigue, and thus strabismus (heterotopia) may be revealed, which causes double vision. The patient, in our case, developed diplopia as a result of stress and fatigue.
Case presentation: The patient underwent treatment with the use of botulinum toxin A. After each procedure, an ophthalmological examination was performed to measure the strabismus angle. Three courses of botulinum toxin A injection reduced the strabismus angle by 86%, the double vision passed.
Conclusions: The case shows the possibility of curing an adult with Botulinum toxin A, in whom latent strabismus has turned into esotropia. Despite its transient kinetics, botulinum toxin A can have a lasting effect on eye alignment, favoring binocularity and reducing double vision, and can serve as a primary treatment. To obtain a permanent result, it is necessary to repeat the treatment.
Abstract
Background: Heterophoria (latent strabismus) is an imbalance in the tone of the oculomotor muscles. In a young child, this disorder usually does not affect the development of binocular vision. While looking, binocular vision (image fusion) keeps the eyeballs straight. With age, binocular vision may be impaired, for example, as a result of trauma, general disease, stress, or severe fatigue, and thus strabismus (heterotopia) may be revealed, which causes double vision. The patient, in our case, developed diplopia as a result of stress and fatigue.
Case presentation: The patient underwent treatment with the use of botulinum toxin A. After each procedure, an ophthalmological examination was performed to measure the strabismus angle. Three courses of botulinum toxin A injection reduced the strabismus angle by 86%, the double vision passed.
Conclusions: The case shows the possibility of curing an adult with Botulinum toxin A, in whom latent strabismus has turned into esotropia. Despite its transient kinetics, botulinum toxin A can have a lasting effect on eye alignment, favoring binocularity and reducing double vision, and can serve as a primary treatment. To obtain a permanent result, it is necessary to repeat the treatment.
Keywords
strabismus; botulinum toxin A; esotropia
About this articleTitle
Treatment of heterophoria with botulinum toxin A — a case study
Journal
Issue
Vol 6 (2021): Continuous Publishing
Article type
Case report
Pages
151-154
Published online
2021-10-13
Page views
6345
Article views/downloads
510
DOI
Bibliographic record
Ophthalmol J 2021;6:151-154.
Keywords
strabismus
botulinum toxin A
esotropia
Authors
Przemysław Raczkiewicz
Barbara Biziorek
References (15)- Rowe FJ, Noonan CP. Botulinum toxin for the treatment of strabismus. Cochrane Database Syst Rev. 2017; 3: CD006499.
- Gunton KB, Wasserman BN, DeBenedictis C. Strabismus. Prim Care. 2015; 42(3): 393–407.
- Cunningham ET, Riordan-Eva P. Vaughan & Asbury's General Ophthalmology. 18th ed. McGraw-Hill Medical, Huckelberry 2011.
- MacEwen C, Gregson R. Manual of strabismus surgery. Butterworth-Heinemann , Oxford 2003.
- Docket No. FDA-2008-P-0061. Food and Drug Administration. United States Department of Health and Human Services.
- Thouvenin D, Lesage-Beaudon C, Arné JL. Injection de toxine botulique dans les strabismes précoces. Efficacité et incidence sur les indications chirurgicales ultérieures. J Franç Ophtalmol. 2008; 31(1): 42–50.
- de Alba Campomanes AG, Binenbaum G, Campomanes Eguiarte G. Comparison of botulinum toxin with surgery as primary treatment for infantile esotropia. J AAPOS. 2010; 14(2): 111–116.
- Mangan MS, Basar E, Mahan M, et al. Pediatric Eye Disease Investigator Group. Botulinum A toxin therapy on esotropia in children. J Med Assoc Thai. 2002; 85(11): 1189–1197.
- Scott AB. Change of eye muscle sarcomeres according to eye position. J Pediatr Ophthalmol Strabismus. 1994; 31(2): 85–88.
- Hered R. Chapter 14: Surgery for extraocular muscles. In: In: 2018-2019 Basic and Clinical Science Course, Section 06: Pediatric Ophthalmology and Strabismus. American Academy Ophthalmology, Philadelphia 2018: 241–242.
- Dressler D. Clinical presentation and management of antibody-induced failure of botulinum toxin therapy. Mov Disord. 2004; 19 Suppl 8: S92–S9S100.
- Rayner SA, Hollick EJ, Lee JP. Botulinum toxin in childhood strabismus. Strabismus. 1999; 7(2): 103–111.
- Scott A, Magoon E, McNeer K, et al. Botulinum Treatment of Childhood Strabismus. Ophthalmology. 1990; 97(11): 1434–1438.
- Lennerstrand G, Nordbø OA, Tian S, et al. Treatment of strabismus and nystagmus with botulinum toxin type A. An evaluation of effects and complications. Acta Ophthalmol Scand. 1998; 76(1): 27–27.
- Elston JS, Lee JP, Powell CM, et al. Treatment of strabismus in adults with botulinum toxin A. Br J Ophthalmol. 1985; 69(10): 718–724.