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Updated: Sep 22, 2025

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Botulinum Toxin A Injection for Convergence Insufficiency.

Mikael Hofsli, Tobias Emil Torp-Pedersen, Claes Sepstrup Lønkvist

    Journal of Pediatric Ophthalmology and Strabismus
    |May 25, 2022
    PubMed
    Summary
    This summary is machine-generated.

    Botulinum toxin A injections may help patients with convergence insufficiency, particularly those who have not responded to other treatments. Some individuals may need repeat treatments for sustained improvement.

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    Area of Science:

    • Ophthalmology
    • Neurology

    Background:

    • Convergence insufficiency (CI) is a common binocular vision disorder characterized by the inability to maintain comfortable binocular vision at near.
    • Patients with CI often experience symptoms such as eye strain, headaches, and double vision, significantly impacting reading and near work.
    • Previous treatments for CI include vision therapy, prism correction, and strabismus surgery, but some patients remain refractory to these interventions.

    Purpose of the Study:

    • To evaluate the efficacy of botulinum toxin A injections in the lateral rectus muscles for managing convergence insufficiency.
    • To assess the outcomes in patients with CI who had previously undergone non-surgical and/or surgical treatments without success.

    Main Methods:

    • A retrospective review of 23 patients with symptomatic convergence insufficiency treated with botulinum toxin A injections between 2013 and 2018.
    • Patients had previously received vision exercises, prisms, or surgery. Botulinum toxin A was injected into one or both lateral rectus muscles.
    • Data on near symptoms and deviation at near and distance were collected at baseline and at 1 and 6 months post-injection.

    Main Results:

    • The median exophoria at near decreased from 18 PD at baseline to 10 PD at the first follow-up and 14 PD at the last follow-up.
    • Fifty-seven percent of patients reported improved reading symptoms at the first follow-up, with 23% reporting improvement at the last follow-up.
    • While initial improvements were observed, the effect on near deviation appeared to diminish over time, suggesting potential for recurrence.

    Conclusions:

    • Botulinum toxin A injection can be a viable treatment option for patients with convergence insufficiency, especially those with a history of failed conventional therapies.
    • The positive effects on reading symptoms and exophoria suggest a potential role for botulinum toxin A in CI management.
    • The need for repeated injections in some patients highlights the importance of long-term monitoring and individualized treatment strategies.