Botulinum Toxin (Botox) Injection in Strabismus Treatment
Botulinum toxin injection (Botox application in strabismus treatment) has been safely used for approximately 20 years as an alternative or complementary method to surgery. In certain types of strabismus, it offers a fast, effective, and practical solution.
How Does Botulinum Toxin Work in Strabismus?
When a very small amount of Botox is injected into an eye muscle, it temporarily weakens that muscle. During this process:
✔ The weakened muscle stretches
✔ The opposing muscle strengthens and tightens
✔ The goal is to maintain the eye in a new, more balanced position
The effects of a botulinum toxin injection begin within 2–3 days. Maximum effect is usually reached within 1–2 weeks, and the effect gradually diminishes over 4–6 months. Although the effect of Botox is temporary, in some patients, this stretch–contract balance can lead to permanent improvement.
When Is Botox Used in Strabismus?
How Is Botulinum Toxin Treatment Applied in Strabismus?
The injection is usually a short procedure lasting 5–6 minutes. Topical anesthetic drops are applied to the eye beforehand. The target muscle is then identified using a small forceps holding the eye muscle, and a very fine needle injects a small amount of botulinum toxin directly into the muscle.
In children, this procedure is performed under short-term mask anesthesia.
What to Expect After a Botox Injection?
Expected temporary effects:
✔ Mild redness or irritation in the eye
✔ Temporary double vision
✔ Drooping eyelid (about 15%, completely temporary)
✔ Vertical deviation of the eye (usually temporary)
Very rarely (1 in 5,000 patients), more serious risks may occur, such as bleeding into the muscle, significant bleeding around the eye, or injection into the eye itself.
Botox or Surgery? Which Is Better?
✔ Botox is simpler, less invasive, and lower cost
✔ It can provide permanent improvement in certain types of strabismus
✔ However, it is not as predictable or definitive as surgery
✔ Studies show that Botox can achieve permanent improvement, especially in small-angle esotropias
✔ If Botox fails, surgery is always an option
✔ Botox injections can be repeated; in some patients, several treatments may be required for permanent balance
It is important for children and adults diagnosed with strabismus to consult a pediatric ophthalmology specialist to determine whether this treatment is appropriate.