Botulinum toxin injection as primary treatment for esotropia in patients with cerebral palsy

Botulinum toxin type A is a potent neurotoxin that blocks the release of acetylocholine at the neuromuscular junction of cholinergic nerves. Cerebral palsy is cause of ocular disorders. There is an increased presence of strabismus, refractive errors, and reduced visual acuity. The purpose of this study was to assess the efficacy of botulinum toxin injection in the treatment of esotropia in patients with cerebral palsy.

Seven patients were included in the study. All patients had a full ophthalmic examination on initial visit, including cycloplegic refraction and duction. The angle of esotropic deviation at distance was recorded in prism diopters. The botulinum toxin type A was administered into the medial rectus muscle under general anesthesia.

Mean age of the patients was 12 years. The mean angle of deviation pretreatment was 36.6 PD. Successful motor alignment (orthotropia +/- 10 PD) was achieved in the botulinum toxin type A group in 57.1% of patients.

The use of botulinum toxin in the treatment of esotropia in children and adolescents with cerebral palsy is an alternative to conventional surgical therapy.