SpringerLink
Log in

Use of Botulinum Toxin in Ophthalmology

  • Chapter
  • First Online:
Botulinum Toxin Therapy

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 263))

  • 1695 Accesses

Abstract

Botulinum toxin is an important treatment for many conditions in ophthalmology, including strabismus, nystagmus, blepharospasm, hemifacial spasm, spastic and congenital entropion, corneal exposure, and persistent epithelial defects. The mechanism of action of botulinum toxin for both strabismus and nystagmus is the neuromuscular blockade and transient paralysis of extraocular muscles, but when botulinum toxin is used for some forms of strabismus, a single injection can convey indefinite benefits. There are two unique mechanisms of action that account for the long-term effect on ocular alignment: (1) the disruption of a balanced system of agonist-antagonist extraocular muscles and (2) the reestablishment of central control of alignment by the binocular visual system. For other ocular conditions, botulinum toxin acts through transient paralysis of periocular muscles. Botulinum toxin is a powerful tool in ophthalmology, achieving its therapeutic effects by direct neuromuscular blockade of extraocular and periocular muscles and by unique mechanisms related to the underlying structure and function of the visual system.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 117.69
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
EUR 160.49
Price includes VAT (Germany)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
EUR 160.49
Price includes VAT (Germany)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Ababneh OH, Cetinkaya A, Kulwin DR (2014) Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm. Clin Exp Ophthalmol 42(3):254–261

    PubMed  Google Scholar 

  • Adams GG, Kirkness CM, Lee JP (1987) Botulinum toxin A induced protective ptosis. Eye 1(Pt 5):603–608

    PubMed  Google Scholar 

  • Albanese A, Bentivoglio AR, Colosimo C, Galardi G, Maderna L, Tonali P (1996) Pretarsal injections of botulinum toxin improve blepharospasm in previously unresponsive patients. J Neurol Neurosurg Psychiatry 60(6):693–694

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bilyk JR, Yen MT, Bradley EA, Wladis EJ, Mawn LA (2018) Chemodenervation for the treatment of facial dystonia: a report by the American Academy of Ophthalmology. Ophthalmology 125(9):1459–1467

    PubMed  Google Scholar 

  • Cakmur R, Ozturk V, Uzunel F, Donmez B, Idiman F (2002) Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm. J Neurol 249(1):64–68

    CAS  PubMed  Google Scholar 

  • Christiansen G, Mohney BG, Baratz KH, Bradley EA (2004) Botulinum toxin for the treatment of congenital entropion. Am J Ophthalmol 138(1):153–155

    CAS  PubMed  Google Scholar 

  • Cillino S, Raimondi G, Guepratte N et al (2010) Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes. Eye 24(4):600–607

    CAS  PubMed  Google Scholar 

  • Clarke JR, Spalton DJ (1988) Treatment of senile entropion with botulinum toxin. Br J Ophthalmol 72(5):361–362

    CAS  PubMed  PubMed Central  Google Scholar 

  • Dawson EL, Marshman WE, Adams GG (1999a) The role of botulinum toxin A in acute-onset esotropia. Ophthalmology 106(9):1727–1730

    CAS  PubMed  Google Scholar 

  • Dawson EL, Marshman WE, Lee JP (1999b) Role of botulinum toxin A in surgically overcorrected exotropia. J AAPOS 3(5):269–271

    CAS  PubMed  Google Scholar 

  • Deka A, Saikia SP (2011) Botulinum toxin for lower lid entropion correction. Orbit 30(1):40–42

    PubMed  Google Scholar 

  • Dutton JJ, Fowler AM (2007) Botulinum toxin in ophthalmology. Surv Ophthalmol 52(1):13–31

    PubMed  Google Scholar 

  • Ellis MF, Daniell M (2001) An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis. Clin Exp Ophthalmol 29(6):394–399

    CAS  PubMed  Google Scholar 

  • Foster JA, Carter KD, Durairaj VD, Kavanagh MC, Korn BS, Nelson CC, Hartstein ME (2017) Basic and clinical science course, section 7: orbit, eyelids, and lacrimal system. American Academy of Ophthalmology, San Francisco

    Google Scholar 

  • Gardner R, Dawson EL, Adams GG, Lee JP (2008) Long-term management of strabismus with multiple repeated injections of botulinum toxin. J AAPOS 12(6):569–575

    PubMed  Google Scholar 

  • Hallett M, Albanese A, Dressler D et al (2013) Evidence-based review and assessment of botulinum neurotoxin for the treatment of movement disorders. Toxicon 67:94–114

    CAS  PubMed  Google Scholar 

  • Heyworth PL, Lee JP (1994) Persisting hypotropias following protective ptosis induced by botulinum neurotoxin. Eye 8(Pt 5):511–515

    PubMed  Google Scholar 

  • Huang W, Foster JA, Rogachefsky AS (2000) Pharmacology of botulinum toxin. J Am Acad Dermatol 43(2 Pt 1):249–259

    CAS  PubMed  Google Scholar 

  • Jankovic J (1996) Pretarsal injection of botulinum toxin for blepharospasm and apraxia of eyelid opening. J Neurol Neurosurg Psychiatry 60(6):704

    CAS  PubMed  PubMed Central  Google Scholar 

  • Kao LY, Chao AN (2003) Subtenon injection of botulinum toxin for treatment of traumatic sixth nerve palsy. J Pediatr Ophthalmol Strabismus 40(1):27–30

    PubMed  Google Scholar 

  • Kasaee A, Musavi MR, Tabatabaie SZ et al (2010) Evaluation of efficacy and safety of botulinum toxin type A injection in patients requiring temporary tarsorrhaphy to improve corneal epithelial defects. Int J Ophthalmol 3(3):237–240

    PubMed  PubMed Central  Google Scholar 

  • Khan AO (2005) Two horizontal rectus eye muscle surgery combined with botulinum toxin for the treatment of very large angle esotropia. A pilot study. Binocul Vis Strabismus Q 20(1):15–20

    PubMed  Google Scholar 

  • Lee J, Harris S, Cohen J, Cooper K, MacEwen C, Jones S (1994) Results of a prospective randomized trial of botulinum toxin therapy in acute unilateral sixth nerve palsy. J Pediatr Ophthalmol Strabismus 31(5):283–286

    CAS  PubMed  Google Scholar 

  • Lee C, Kikkawa DO, Pasco NY, Granet DB (2005) Advanced functional oculofacial indications of botulinum toxin. Int Ophthalmol Clin 45(3):77–91

    PubMed  Google Scholar 

  • Leigh RJ, Zee DS (2015) The neurology of eye movements, 5th edn. Oxford University Press, New York

    Google Scholar 

  • Lennerstrand G, Nordbo OA, Tian S, Eriksson-Derouet B, Ali T (1998) Treatment of strabismus and nystagmus with botulinum toxin type A. An evaluation of effects and complications. Acta Ophthalmol Scand 76(1):27–27

    CAS  PubMed  Google Scholar 

  • Liu M, Lee HC, Hertle RW, Ho AC (2004) Retinal detachment from inadvertent intraocular injection of botulinum toxin A. Am J Ophthalmol 137(1):201–202

    PubMed  Google Scholar 

  • Lueder GT, Galli M, Tychsen L, Yildirim C, Pegado V (2012) Long-term results of botulinum toxin-augmented medial rectus recessions for large-angle infantile esotropia. Am J Ophthalmol 153(3):560–563

    PubMed  Google Scholar 

  • Marion MH, Sheehy M, Sangla S, Soulayrol S (1995) Dose standardisation of botulinum toxin. J Neurol Neurosurg Psychiatry 59(1):102–103

    CAS  PubMed  PubMed Central  Google Scholar 

  • Minguini N, de Carvalho KM, Bosso FL, Hirata FE, Kara-Jose N (2012) Surgery with intraoperative botulinum toxin-A injection for the treatment of large-angle horizontal strabismus: a pilot study. Clinics 67(3):279–282

    PubMed  PubMed Central  Google Scholar 

  • Naik MN, Gangopadhyay N, Fernandes M, Murthy R, Honavar SG (2008) Anterior chemodenervation of levator palpebrae superioris with botulinum toxin type-A (Botox) to induce temporary ptosis for corneal protection. Eye 22(9):1132–1136

    CAS  PubMed  Google Scholar 

  • Pediatric Eye Disease Investigator Group, Christiansen SP, Chandler DL et al (2016) Tonic pupil after botulinum toxin-A injection for treatment of esotropia in children. J AAPOS 20(1):78–81

    PubMed Central  Google Scholar 

  • Pehere N, Jalali S, Mathai A, Naik M, Ramesh K (2011) Inadvertent intraocular injection of botulinum toxin A. J Pediatr Ophthalmol Strabismus 48:e1–e3

    PubMed  Google Scholar 

  • Ross AH, Elston JS, Marion MH, Malhotra R (2011) Review and update of involuntary facial movement disorders presenting in the ophthalmological setting. Surv Ophthalmol 56(1):54–67

    PubMed  Google Scholar 

  • Rowe FJ, Noonan CP (2017) Botulinum toxin for the treatment of strabismus. Cochrane Database Syst Rev 3:CD006499

    PubMed  Google Scholar 

  • Sampaio C, Ferreira JJ, Simoes F et al (1997) DYSBOT: a single-blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A – Dysport and Botox – assuming a ratio of 4:1. Mov Disord 12(6):1013–1018

    CAS  PubMed  Google Scholar 

  • Sanjari MS, Falavarjani KG, Kashkouli MB, Aghai GH, Nojomi M, Rostami H (2008) Botulinum toxin injection with and without electromyographic assistance for treatment of abducens nerve palsy: a pilot study. J AAPOS 12(3):259–262

    PubMed  Google Scholar 

  • Sarkies NJ (1999) A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective. Eye 13(Pt 2):273

    PubMed  Google Scholar 

  • Scaglione F (2016) Conversion ratio between Botox(R), Dysport(R), and Xeomin(R) in clinical practice. Toxins 8(3):65

    PubMed Central  Google Scholar 

  • Scott AB (1980) Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology 87(10):1044–1049

    CAS  PubMed  Google Scholar 

  • Scott AB (1994) Change of eye muscle sarcomeres according to eye position. J Pediatr Ophthalmol Strabismus 31(2):85–88

    CAS  PubMed  Google Scholar 

  • Scott AB, Rosenbaum A, Collins CC (1973) Pharmacologic weakening of extraocular muscles. Investig Ophthalmol 12(12):924–927

    CAS  Google Scholar 

  • Shumway CL, Wade M (2019) Anatomy, head and neck, eye extraocular muscles. StatPearls, Treasure Island

    Google Scholar 

  • Staube A, Büttner U (2007) Neuro-ophthalmology: neuronal control of eye movements, vol 40. Karger, Basel

    Google Scholar 

  • Steel DH, Hoh HB, Harrad RA, Collins CR (1997) Botulinum toxin for the temporary treatment of involutional lower lid entropion: a clinical and morphological study. Eye 11(Pt 4):472–475

    PubMed  Google Scholar 

  • Tejedor J, Rodriguez JM (1998) Retreatment of children after surgery for acquired esotropia: reoperation versus botulinum injection. Br J Ophthalmol 82(2):110–114

    CAS  PubMed  PubMed Central  Google Scholar 

  • Tejedor J, Rodriguez JM (1999) Early retreatment of infantile esotropia: comparison of reoperation and botulinum toxin. Br J Ophthalmol 83(7):783–787

    CAS  PubMed  PubMed Central  Google Scholar 

  • Tejedor J, Rodriguez JM (2007) Management of nonresolving consecutive exotropia following botulinum toxin treatment of childhood esotropia. Arch Ophthalmol 125(9):1210–1213

    CAS  PubMed  Google Scholar 

  • Tomsak RL, Remler BF, Averbuch-Heller L, Chandran M, Leigh RJ (1995) Unsatisfactory treatment of acquired nystagmus with retrobulbar injection of botulinum toxin. Am J Ophthalmol 119(4):489–496

    CAS  PubMed  Google Scholar 

  • Wan MJ, Mantagos IS, Shah AS, Kazlas M, Hunter DG (2017) Comparison of botulinum toxin with surgery for the treatment of acute-onset comitant esotropia in children. Am J Ophthalmol 176:33–39

    CAS  PubMed  Google Scholar 

  • Wan MJ, Gilbert A, Kazlas M et al (2018) The effect of botulinum toxin augmentation on strabismus surgery for large-angle infantile esotropia. Am J Ophthalmol 189:160–165

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments/Disclosures

Funding/Support: Children’s Hospital Ophthalmology Foundation, Inc., Boston, MA (DGH).

Financial Disclosures: Dr. Hunter is founder and board member of Rebion, Inc. and advisor to Luminopia, Inc. Neither is of relevance to the content of this chapter.

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada

    Michael J. Wan & Sara AlShaker

  2. Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada

    Michael J. Wan

  3. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    David G. Hunter

  4. Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, USA

    David G. Hunter

Authors
  1. Michael J. Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara AlShaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David G. Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David G. Hunter .

Editor information

Editors and Affiliations

  1. Akrivista and Whitecap Biosciences, Irvine, CA, USA

    Scott M. Whitcup

  2. Bethesda, MD, USA

    Mark Hallett

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wan, M.J., AlShaker, S., Hunter, D.G. (2019). Use of Botulinum Toxin in Ophthalmology. In: Whitcup, S.M., Hallett, M. (eds) Botulinum Toxin Therapy. Handbook of Experimental Pharmacology, vol 263. Springer, Cham. https://doi.org/10.1007/164_2019_325

Download citation

Publish with us

Policies and ethics

Search

Navigation