Botulinum toxin for the treatment of dysthyroid ocular myopathy

Eight consecutive patients with acquired deviations due to dysthyroid ocular myopathy were injected with botulinum A toxin for relief of their diplopia. Seven patients were acute in the onset of symptoms and one was chronic. All showed improvement in motility and experienced a reduction if not total relief of their symptoms. Six patients required reinjection. Complications were limited to transient ptosis, transient involvement of adjacent muscles and transient but prolonged paralysis that eventually resolved. No systemic complications were noted. We conclude that chemodenervation with botulinum A toxin may have a role in the management of dysthyroid ocular myopathy not amenable to prism treatment and may act as an adjunct to or eliminate the need for surgical correction in some patients.