Related Experiment Video
Updated: Jul 15, 2026

Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Optic neuropathy associated with botulinum A toxin in thyroid-related orbitopathy
Bobby S Korn1, Seong-Wook Seo, Leah Levi
1Thyroid Eye Center, Department of Ophthalmology, University of California, San Diego School of Medicine, La Jolla, California 92093-0946, USA.
Purpose:
To report the development of optic neuropathy after botulinum A toxin injection for restrictive myopathy from thyroid-related orbitopathy (TRO).
Methods:
We retrospectively reviewed the records of three patients with TRO who underwent botulinum A toxin injection for restrictive myopathy and subsequently developed optic neuropathy. Development of optic neuropathy was measured by visual acuity, color vision testing, visual field testing, and relative afferent pupillary testing.
Results:
At 3 week follow-up after botulinum A toxin injection, three patients were noted to have clinical signs and symptoms of optic neuropathy in the ipsilateral eye following injection of botulinum A toxin for restrictive myopathy. Treatment with oral steroids followed by orbital wall decompression reversed the optic neuropathy.
Conclusions:
To our knowledge, this is the first report of optic neuropathy associated with botulinum A toxin injection in TRO. Clinicians should be aware of this potential vision threatening complication.
Related Concept Videos
Graves' Disease I: Introduction
Botulism
Glaucoma: Overview
Hyperthyroidism II: Pathophysiology
Graves Disease II: Pathophysiology
Accessory Structures of the Eye