Botulinum toxin A therapy for medial rectus injury during endoscopic sinus surgery

Although the use of endoscopes and image guidance provide some safeguards, motility complications from orbital injury during endoscopic sinus surgery still pose a significant concern and can provide a therapeutic challenge.

We present the case of a 40-year-old woman with strabismus secondary to an iatrogenic injury to the medial rectus muscle during endoscopic sinus surgery.

Permanent resolution of diplopia was achieved with botulinum toxin A injection into the lateral rectus muscle without the need for surgical intervention.

Botulinum toxin A should be considered as a first-line early therapeutic option for cases of iatrogenically induced strabismus after endoscopic sinus surgery when complete transection or entrapment is not present.