Botulinum toxin injection into the superior rectus muscle of the non-dominant eye for dissociated vertical deviation

A variety of surgical procedures on the superior rectus muscles have been proposed as a remedy for Dissociated Vertical Deviation (DVD); Botulinum toxin (Oculinum) has been one such suggestion as a surgical alternative. We selected five older patients with DVD whose age placed them beyond a risk of amblyopia to evaluate Oculinum injection into the superior rectus muscle as therapy for DVD. The patients achieved a reduction from the mean value of 20 prism diopters to the mean value of less than 5 pd hypertropia at 172 weeks following injection. Our study suggests that Oculinum is effective in treating DVD, but caution should be exercised because transient ptosis invariably accompanies injection.