Pharmacological treatment of strabismus in children

Abstract

Purpose The aim of this study was to assess the change in alignment following a fixed dose of bupivacaine (BPX) and/or botulinum A toxin (BTXA) injection into the extraocular muscles in children with concomitant horizontal strabismus. Patients and methods This prospective interventional study was conducted on 76 children aged 2–14 years with concomitant horizontal strabismus. They were divided into three groups. In group A (20 cases) with angle of strabismus less than 16 prism diopters (PD), BPX 0.75% was injected into the agonist muscle of each eye. In group B (23 patients) with angle of 16–30 PD, BTXA 5 U was injected into the antagonist muscle of each eye. In group C (33 patients) with angle greater than 30 PD, BPX 0.75% and BTXA 5 U were injected into the agonist and antagonist muscles of each eye, respectively. Ocular motility and alignment were evaluated preoperatively and at 1 week, 1, 3, and 6 months postoperatively. Results In group A, 11 (55%) patients were orthotropic, six (30%) had residual esotropia (ET), and three (15%) had residual exotropia (XT). The mean preinjection angle was 13.55±2.56 PD, and the postinjection angle was 8.45±6.13 PD (P=0.001). In group B, eight (34.8%) patients were orthotropic, two (8.7%) had residual ET, and 13 (56.5%) had residual XT. The mean preinjection angle was 28.0±3.28 PD, and the mean postinjection angle was 15.25±10.79 PD (P<0.001). In group C, 10 (30.3%) patients were orthotropic, 14 (42.2%) had residual ET, and nine (27.2%) had residual XT. The mean preinjection angle was 52.50±14.03 PD, and the mean postinjection angle was 24.75±21.32 PD (P<0.001). Conclusion Pharmacological treatment resulted in clinically significant correction of concomitant horizontal strabismus in children and may be used as an alternative to surgery.