Botulinum toxin therapy in dysthyroid strabismus

We report our experience with the use of Botulinum toxin injection in 38 patients (64 injections) with severe dysthyroid strabismus. Three quarters of the injections led to a decrease in the angle of the squint by a mean 75% of the initial deviation. The average duration of effect was two months. Twenty six patients went on to surgery after stabilisation of their squint and endocrine status. Six patients achieved a stable long-term result with Botulinum toxin only. We suggest these results of treatment of early dysthyroid myopathy are more consistent with the characteristics of inflammatory spasm than contracture. The value of Botulinum toxin as a temporary means of maintaining binocularity in these young patients is discussed.