Botox injections for the correction of strabismus

Botox was originally used for treating strabismus (squint / cross eye). It is still a frequently used treatment worldwide. It has been used at Moorfields Eye Hospital in London since 1982. This treatment has been used at Eye & Laser Surgeons since 2012. Dr Shanel Sharma trained to undertake Botox for strabismus whilst undertaking her Fellowships in Strabismus at Moorfields Eye Hospital and The Western Eye Hospitals in London.

We share a case of a Mr AB. He had two previous squint surgeries to try to correct his childhood strabismus, one in 1997 and again in 2007 whilst living in England. These treatments only lasted a few years for Mr AB. In 2010, as his strabismus was too small an angle to treat with surgery, but obvious to Mr AB and his friends, Botox injections were commenced to keep his eyes aligned whilst living in London. Since moving to Australia he was referred to Dr Sharma for ongoing maintenance treatment.

So how does it work? Anaesthetic drops are put in the eye.  Electrodes are attached. An EMG guided injection is then given to relax the chosen muscle. This procedure is less invasive than surgery and the injection is given within the clinic during a consultation. Botox is an additional treatment for strabismus alongside using prisms, surgery, or occlusion treatment. Every patient needs to be assessed to determine which is the best option for their case.

The figure below demonstrates the effect of Botox treatment. Before treatment, the right eye is turned in (top image), and two weeks after treatment, the two eyes are well aligned (bottom image).
Strab Botox


The effect on quality of life of long-term botulinum toxin A injections to maintain ocular alignment in adult patients with strabismus. Hancox J, Sharma SHANEL, MacKenzie K, Adams GA. British Journal of Ophthalmology. 2012;96(6) 838-40.