Squint Surgery

What are the Indications for the Use of Botox Treatment?

Botox is effective as an alternative to surgery to realign the eyes of selected patients with congenital or acquired strabismus. The toxin appears to be more effective in esotropia (in-turning of the eyes) of small to moderate angles than in exotropia (out-turning), vertical deviations, or large angle deviations.

Botox may prevent contracture of opposing eye muscles in cases of eye muscle palsy from which some recovery is expected. In these cases, single binocular vision may be enabled or enhanced during the recovery phase, and late contractures that would require surgery may be prevented.

Is Botox Safe?

Since 1990, success rates of over 90% have been reported in medical literature. Wide attention has been given to Botox and more and more applications have been found for it, often with equally impressive success rates. Botox is now the treatment choice for muscular spasms affecting the face, and repeated studies have demonstrated that it is a very safe and effective treatment.

How is Botox Used?

Injections into the target muscle are carried out by a very fine needle. The sites of the injection will vary slightly from patient to patient, and according to the ophthalmologist's preference.

How Long Does it Take to Work?

Benefits begin in 1-14 days after the treatment and last on average three to four months, after which it can be repeated. All effects of the toxin ultimately reverse with time.

What Are Its Side Effects and Complications?

Many studies have confirmed side effects to be minor in the vast majority of applications. Side effects are generally transitory, well tolerated, and amenable to treatment. They are related to the dose of Botox administered. Persistent complications are distinctly rare, and serious side effects are uncommon. Some of the reported side effects include:

Flu like symptoms. These are mild and transient.
Systemic complications are uncommon
Pain at the site of injection, and headaches again mild and transient.
Muscle weakness. This is to be expected in the muscles injected but in practice this is rarely a problem.
Weakness in other areas is rarely troublesome and is associated with large doses.
Allergy is a theoretical risk but is virtually unknown.
Antibodies can be produced and if this happens the toxin becomes ineffective, but there are no other effects. The antibodies often disappear with time and treatment may be successfully recommenced after an interval.
Other very low incidence of complications of botulinum toxin injections includes droopy eye (ptosis), dry eye and photosensitivity. One of the more common adverse effects, ptosis, is due to diffusion of toxin from the upper eyelid injection sites to the levator muscle.

Although the side effects of the toxin are generally uncommon and not serious there are nonetheless contraindications to treatment with botulinum toxin. Please telephone the Ophthalmic Surgery Centre for further details.

Pregnancy and lactation.
Infection in the vicinity of the injection site.
Current therapy with a certain class of uncommonly used antibiotics, known as the amino glycosides.
Blood clotting disorders or current therapy with drugs inhibiting blood clotting, e.g. Warfarin.
Diseases affecting the muscles, particularly myaesthenia gravis.
Allergy to tetanus toxoid is a potential, but not absolute contraindication.

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