Does BOTOX injection in Rectus Medialis relieve esotropia?

Discussion in 'Optometry Archives' started by fresnelp, Jan 23, 2005.

  1. fresnelp

    fresnelp Guest

    Hi all,

    My Doctor recommended surgical "loosening" of my recti mediali in order
    to relieve me of esotopia of 5-10 prisms. Given the small deviation, is
    it better that this "loosening" be achieved through BOTOX injections in
    these muscles?

    Thank you in advance,
    Peter
     
    fresnelp, Jan 23, 2005
    #1
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  2. fresnelp

    RM Guest

    I am not sure you can get a graded (=partial) response by using Botox. Of
    course you need some normal functioning of the medial rectus for normal eye
    movements.

    Interesting idea but I don't think it's practical.
     
    RM, Jan 23, 2005
    #2
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  3. wrote in @z14g2000cwz.googlegroups.com:
    Botox is hard to finely control, and you have to go through it every six
    months or so. Just because it works well once, it doesn't follow that all
    will go perfect the next time.

    Scott
     
    Scott Seidman, Jan 24, 2005
    #3
  4. Actually, since I do do BOTOX injections like this, I can tell you that the
    whole outcome depends on presence or absence of fusion.

    If fusion is present, while BOTOX actually "wears off" in 1-2 months, the
    effect may be a permanent realignment, with the fusion lock holding the eye
    straight.

    (I use "", since BOTOX actually doesn't wear off; it is a permanent binding
    to the acetylcholine receptors. The effect wears off, since new muscle
    endplates regenerate, which are not blocked.)

    If there is no fusion lock, the alignment effect is unpredictable, and once
    it achieves steady-state, may last, as others said, 6-12 months. This is
    because the eye wants to remain in the state is was originally, with
    nothings to hold it in alignment.

    Now, with this 5-10 prism esotropia - it is acquired, such as from a mild
    6th nerve paresis, with diplopia, or is it long standing, with supression?
    In the former case, one could try BOTOX, but there is a small chance of
    overcorrection, and a larger chance of undercorrection. (Would use a smaller
    than average dose, since the angle is so small.)

    In the latter case, BOTOX would be not be useful long term, but neither
    would a small prism. Is this esotropia cosmetic? - such a small angle is
    often not noticeable.

    Surgery would be more titrateable, but you don't usually operate for such a
    small angle. The typical surgical dose table (M. Parks, et al) starts at a
    15 prism angle, with bi-medial surgery of 3.0 mm. For smaller angles one
    could do one muscle only.

    Personally, I recommend prism, as this optical correction is non-invasive.
    The issue is, if there is diplopia, it would be there when the glasses are
    off. Also, if one is not usually wearing glasses, this puts you into
    glasses.

    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and strabismus subspecialty
    Member of AAPOS
    (American Academy of Pediatric Ophthalmology and Strabismus)
     
    David Robins, MD, Apr 15, 2005
    #4
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