Abstract
Botulinum toxin A induced ptosis (BTXAP) has become an established method for producing a temporary ptosis for corneal protection. Adams et al1 reported from an initial series of 15 patients and observed that the ptosis lasted for a mean period of 2.5 weeks and that full recovery was achieved after a mean of 8.1 weeks. They noted that in 80% of cases there was a temporary superior rectus weakness which lasted for a mean of 6 weeks. We present three cases in which the superior rectus weakness was permanent and required corrective strabismus surgery. We believe that these are the first cases reported. We propose two possible mechanisms which may be acting together: firstly that a prolonged period of occlusion may have led to a breakdown of fusion, and secondly that following botulinum toxin induced superior rectus weakness there was contracture of the ipsilateral antagonist muscle further disrupting fusional mechanisms.
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References
Adams GGW, Kirkness CM, Lee JP . Botulinum toxin A induced protective ptosis. Eye 1987;1:603–8.
Burgen ASV, Dickens F, Zatman LJ . The action of botulinum toxin on the neuro-muscular junction. J Physiol (Lond) 1949;109:10–24.
Duchen LW, Strich SJ . The effects of botulinum toxin on the pattern of innervation of skeletal muscle in the mouse. Q J Exp Physiol 1968;53:84–9.
Duchen LW . Changes in the electron microscopic structure of slow and fast skeletal muscle fibres in the mouse after local injection of botulinum toxin. J Neurol Sci 1971;14:61–74.
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Heyworth, P., Lee, J. Persisting hypotropias following protective ptosis induced by botulinum neurotoxin. Eye 8, 511–515 (1994). https://doi.org/10.1038/eye.1994.127
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DOI: https://doi.org/10.1038/eye.1994.127
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