[Using a botuline toxin diagnostic test in a case of bilateral stilling--Türk--Duane (STD) syndrome found during...

The presentation of complex procedures in preoperative diagnosis, allowing the evaluation of reaction of a patient with bilateral STD syndrome, to a potential change in the long-lasting ocular motility disturbances and corrective head position.

The botuline toxin was injected into the medial rectus muscle of the eye with greater motility disturbance in convergent strabismus. It was discovered during preparation for cataract surgery in a 45 years old female with STD Syndrome I type. Due to reduced visual acuity the diagnosis of binocular vision were performed after bilateral cataract surgery. We were afraid that the fixed sensory status of the patient would change, and therefore we performed botuline injections. Strabismus angle, ocular motility and diplopia were assessed and compared.

The reduction of strabismus angle was achieved with no diplopia. The patient no longer needed the corrective head position, with binocular vision present while looking straight ahead. Also, a slight improvement was obtained in the abduction motility of the eye to which botuline toxin was injected.

Preoperative diagnostic botuline toxin injection into the rectus medial muscle of the eye with greater motility disturbance, gives an effect of strabismus reduction. This allows for further decisions of whether, and what type of surgical treatment should be performed.