Treatment Of Strabismus Research Articles

Predictive factors of stereopsis outcomes following strabismus surgery.

Purpose:To determine the predictive factors of post-operative stereopsis in patients with strabismus.Method:In this retrospective study, records of patients who received surgical treatment for strabismus were reviewed. All types of strabismus were included. Pre- and post-treatment stereoacuity were measured using the Titmus Stereo Fly test, and predictive factors of stereopsis were evaluated.Results:A total of 194 patients (132 females and 62 males) with a mean age of 14.8 ± 8.4 years were included. There was a statistically significant improvement in stereopsis following surgery (p value < 0.001). Patients with a higher amount of deviation at baseline had poorer stereopsis on the final examination (p value < 0.001). Stereopsis improvement was more prominent in the pure horizontal strabismus group, compared to combined horizontal and vertical deviations. Baseline and the final stereopsis were higher in the “exotropia” group as compared to the “esotropia” group (p value = 0.003 and 0.0155, respectively); however, the within group change of stereopsis was not significantly different between these two groups (p value = 0.144). Post surgical residual deviation was associated with a poorer stereopsis (p value = 0.002, r = 0.251). A longer duration of strabismus before surgery was associated with poorer final stereopsis levels (p value = 0.026). The presence of amblyopia before surgery was associated with poorer stereopsis on last examination (p value < 0.001 for both correlations).Conclusion:Based on the result of this study, final stereopsis after strabismus surgery could be affected by the type, duration, and the amount of deviation before surgery, amblyopia, and post operative ocular deviation.

Wright hang-back recession with fibrin glue compared with standard fixed suture recession for the treatment of horizontal strabismus

ObjectiveTo evaluate the clinical safety and efficacy of the novel Wright hang-back recession with fibrin glue for the treatment of horizontal strabismus. Study DesignRetrospective, case-controlled clinical study comparing surgical outcomes of the Wright hang-back rectus recession with fibrin glue (WHBG) versus standard fixed suture rectus recession (SFR). MethodsMedical records of all patients who underwent strabismus surgery by one strabismus surgeon between 2016 and 2018 for horizontal deviations only, including cases of WHBG (group 1) or SFR (group 2), were reviewed. Good surgical outcome was defined as a postoperative deviation ≤10 prism diopters (PD) at a minimum 2 months of follow-up. Results32 eyes of 17 patients underwent WHBG and 32 eyes of 17 patients underwent SFR; in each group, 35% had esotropia and 65% had exotropia. Mean preoperative deviations between groups were similar: esotropia 25.5 PD and exotropia 26.6 PD in WHBG; esotropia 28.3 PD and exotropia 23.8 PD in SFR. The mean postoperative deviation was <7 PD for both groups. Good surgical outcomes were similar between groups, 16/17 (94%) in WHBG and 15/17 (88%) in SFR, with no complications. ConclusionsWHBG was safe and effective with postoperative results similar to SFR. WHBG has an important advantage, eliminating the complication of retinal perforation that can occur with SFR while avoiding under- or overcorrection that can occur with traditional hang-back recession. This technique increases patient safety without sacrificing surgical outcomes and is especially useful in patients with thin sclera such as patients with high myopia or with difficult posterior exposure.

Engineering Botulinum Neurotoxins for Enhanced Therapeutic Applications and Vaccine Development.

Botulinum neurotoxins (BoNTs) show increasing therapeutic applications ranging from treatment of locally paralyzed muscles to cosmetic benefits. At first, in the 1970s, BoNT was used for the treatment of strabismus, however, nowadays, BoNT has multiple medical applications including the treatment of muscle hyperactivity such as strabismus, dystonia, movement disorders, hemifacial spasm, essential tremor, tics, cervical dystonia, cerebral palsy, as well as secretory disorders (hyperhidrosis, sialorrhea) and pain syndromes such as chronic migraine. This review summarizes current knowledge related to engineering of botulinum toxins, with particular emphasis on their potential therapeutic applications for pain management and for retargeting to non-neuronal tissues. Advances in molecular biology have resulted in generating modified BoNTs with the potential to act in a variety of disorders, however, in addition to the modifications of well characterized toxinotypes, the diversity of the wild type BoNT toxinotypes or subtypes, provides the basis for innovative BoNT-based therapeutics and research tools. This expanding BoNT superfamily forms the foundation for new toxins candidates in a wider range of therapeutic options.

Study of awareness, perception about strabismus and social impact of strabismus in adults attending tertiary care centre

Aim: Strabismus is the common condition seen in children and adults in our society. Strabismus has variety of psychosocial impact that can affect the quality of life of the patients. Proper education and awareness regarding the condition can help to rule out the myths associated with strabismus and also building up the personality of the patients. This study was done to know the level of awareness, knowledge about the strabismus in our population and the social impact of strabismus in patients life. Material and Methods: Cross sectional study conducted on 196 patients with strabismus attending outpatient department of Minto Ophthalmic Hospital, regional institute of ophthalmology were included in the study. After taking informed consent, face to face interview conducted asking questions from structured questionnaire prepared. Data collected and analysed with descriptive statistics. Results: Out of 196 patients included in the patients, 128 were males and 68 females. About 9.6 % of patients, were unaware of the condition of strabismus, 56.3% were unaware that squint can cause visual disturbance, 63% were unaware of that strabismus can be treated, 37% of people felt like surgery is the only mode of treatment for strabismus. 60% of the study population expressed that they were rejected for being married due to strabismus because of cosmetic affect, 42.4% felt like squint can hinder the social leadership, 36 % had difficulty in getting job, 28% of the patients expressed being criticized by their friends that lowered their confidence, 75% of the patients felt that they look ugly because of strabismus. Conclusion: Strabismus apart from causing ocular problems, is associated with many psycho-social impact on life of patients. There is lack of awareness regarding the strabismus in our population. Attitude and perception of society towards patients with strabismus will affect the overall confidence, personality of the patients and hence affect quality of life. Hence awarenes

Эффективность тенорафии в хирургическом лечении содружественного косоглазия

Эффективность тенорафии в хирургическом лечении содружественного косоглазия

Long-term clinical effects of the bilateral superior oblique tendon suture spacer in the treatment of A-pattern strabismus

Objective: To investigate the long-term clinical efficacy and safety of the bilateral superior oblique tendon suture spacer in treatment of A-pattern strabismus with superior oblique overaction (SOOA). Methods: Retrospective case series study. Twenty-one A-pattern strabismus patients who received the quantitative bilateral superior oblique tendon suture spacer with a complete follow-up from January 2009 to August 2017 were enrolled. Among these patients, 19 were exotropic and 2 were esotropic, including 11 males and 10 females, aged (14±9) years. Patients with unilateral superior oblique overaction, Broun syndrome or Helveston syndrome were excluded. The A-pattern strabismus, objective torsion, function of the superior oblique muscle and binocular vision were examined pre-and post-operatively. Paired t-test was used for normal distribution data, Wilcoxon rank-sum test was used for non-normal distribution data, Spearman rank correlation test and simple linear regression were used to analyze the correlation between the two variables. Results: The follow-up was 12 to 109 months (mean, 26±17 months). Twenty patients showed good alignment in the primary position with a deviation angle less than 10 prism diopter (PD), and 1 patient with esotropia had an angle greater than 15 PD. All the patients had no A pattern after surgery. The average pre-and post-operative A-patterns were (23.81±9.47) PD and (0.90±3.59) PD (t=11.29, P<0.01), respectively, and the average corrected A pattern was (23.52±9.68) PD.The average pre-and post-operative torsion was 3.18°±3.26° and -4.81°±4.13° (t=8.87, P<0.01), espectively, and the average corrected torsion was 7.95°±3.88°. No patient complained of torsional diplopia after surgery. The average amount of pre-and post-operative SOOA was 3.0 (2.0) and 0.0 (1.0) in 42 eyes (Z=-5.78, P<0.01), respectively. Suture extension of the superior oblique tendon was related with the pre-operative SOOA (r=0.47, P<0.01), but was not related with the pre-operative torsion (r=0.02, P=0.88). The linear regression results was suture extension=2.71× the grade of pre-operative SOOA (t=27.93, P<0.01). Conclusions: The bilateral superior oblique tendon suture spacer can improve the A-pattern, objective torsion and SOOA, with no torsional diplopia or V pattern after the long-term follow-up. It is a safe and effective superior oblique muscle weakening procedure. (Chin J Ophthalmol, 2020, 56: 853-858).

Manejo del estrabismo asociado al glaucoma de la infancia: serie de casos

ObjectiveTo evaluate the different modalities of treatment of the strabismus related to infantile glaucoma, its complications, and results. MethodsThe clinical history of 7 patients with infantile glaucoma which required strabismus surgical treatment were analyzed. Age at onset of glaucoma, type of glaucoma, glaucoma surgeries, type of strabismus, strabismus surgical treatment and postoperative results were studied. ResultsFour patients required strabismus surgery, two were treated with botulinum toxin and one required both. Primary congenital glaucoma was the most common (71,42%), 14,28% had an anterior segment dysgenesis and 14,28% had secondary glaucoma. Regarding strabismus, 4 patients had exotropia and 3 had esotropia. The main difficulty involved the management of the conjunctiva and the filtering blebs. ConclusionStrabismus is a frequent complication in infantile glaucoma. The management of these patients should be individualized. In our case series, treatment of strabismus improved eye alignment. Surgery should be the mainstay of treatment while preserving the conjunctiva and interfere the less with glaucoma surgeries. Botulinum toxin is a reasonable option when conservative treatment is needed.

Тенорафия как альтернатива резекции в лечении горизонтального косоглазия у детей

Purpose. To evaluate the effectiveness of surgical treatment of horizontal strabismus by modified tenorrhaphy in comparison with standard resection in children. Material and methods. For 3 years (2017–2019), 560 patients with horizontal strabismus at the age from 2 to 14 years were operated. Of these, 288 patients (51.4%) underwent tenorrhaphy using a modified technique (main group) as augmentation surgery, 272 patients (48.6%) underwent classical resection (control group). Results. The average age of patients in the main group was 6 (3.46) years, in the control group – 5.8 (3.34) years. In the main group of patients, orthotropy was achieved in 85.4% of cases, in the control group – in 83.5% of cases, p = 0.523. The residual strabismus angle (up to 5°) was observed in 40 patients (14%) in the main group and in 44 patients (16.5%) in the control group of patients, p = 0.449. In the main group, additional correction of the residual angle was performed on the day after the operation using adjustable suture in 8 patients (2.8%). Reoperation in the long-term period was required for 10 patients (3.7%) in the control group and 3 patients (0.7%) in the main group, p = 0.039. Significant postoperative conjunctival thickening was found in 7.2% of patients in the main group. Conclusion. The effectiveness of tenorrhaphy is not inferior to classical resection and, in combination with recession (tenomyoplasty), gives predictable stable results. The tenorrhaphy method is technically simpler, safer, more physiological, can be easily corrected in the immediate postoperative period, has no risk of «losing» muscle and can be recommended as an alternative method of resection.

Treatment of restrictive strabismus of thyroid associated ophthalmopathy by rectus muscle release and recession combined with orbital fat resection

Treatment of restrictive strabismus of thyroid associated ophthalmopathy by rectus muscle release and recession combined with orbital fat resection

Pharmacology of Botulinum Toxins: From Poison to Remedy

Botulinum toxin (BTX) is produced by autolysis of several strains of Clostridium botulinum, a gram-positive, spore-forming, rod-shaped, strictly anaerobic bacterium. However there are also non-clostridial microorganisms that are enable to produce the toxin. As some other beneficial poison, BTX also fits well the quotations by old scientists and philosophers like “Almost every substance can become a poison but only thing is the dose discriminating the difference” (Paracelsus, XVI century) or “Poisons can be employed as a means for the destruction of life or as agents for the treatment of the sick” (Claude Bernard, XIX century) or “Poison is a medicine, medicine is a poison” (Ahi Evran, XIII century). In the 1980's, Alan Scott first published articles on the use of BTX for the treatment of strabismus. The Food and Drug Administration of the USA (FDA) first approved botulinum toxin for the treatment of strabismus (crossed eye) blepharospasm (uncontrollable eye blinking) in 1989 and for glabellar rhytides in 2002, the first cosmetic indication. Since then BTX has been used for a verity of indications not only dermatological but also non-dermatological indications including on-labelled as well as off-labelled uses. In this review you will find the pharmacological profile of botulinum toxins, i.e., mode of action, pharmacokinetics, adverse effects, indications and contrindications, drug interactions, duration and site of action, etc. Furthermore, current commercial products and novel dosage forms as well as new perspective of BTX use will also be discussed.

Stereotest Comparison: Efficacy, Reliability, and Variability of a New Glasses-Free Stereotest.

PurposeTo test the validity of the ASTEROID stereotest as a clinical test of depth perception by comparing it to clinical and research standard tests.MethodsThirty-nine subjects completed four stereotests twice: the ASTEROID test on an autostereo 3D tablet, a research standard on a VPixx PROPixx 3D projector, Randot Circles, and Randot Preschool. Within 14 days, subjects completed each test for a third time.ResultsASTEROID stereo thresholds correlated well with research standard thresholds (r = 0.87, P < 0.001), although ASTEROID underestimated standard threshold (mean difference = 11 arcsec). ASTEROID results correlated less strongly with Randot Circles (r = 0.54, P < 0.001) and Randot Preschool (r = 0.64, P < 0.001), due to the greater measurement range of ASTEROID (1–1000 arcsec) compared to Randot Circles or Randot Preschool. Stereo threshold variability was low for all three clinical stereotests (Bland–Altman 95% limits of agreement between test and retest: ASTEROID, ±0.37; Randot Circles, ±0.24; Randot Preschool, ±0.23). ASTEROID captured the largest range of stereo in a normal population with test–retest reliability comparable to research standards (immediate r = 0.86 for ASTEROID vs. 0.90 for PROPixx; follow-up r = 0.68 for ASTEROID vs. 0.88 for PROPixx).ConclusionsCompared to clinical and research standards for assessing depth perception, ASTEROID is highly accurate, has good test–retest reliability, and measures a wider range of stereo threshold.Translational RelevanceThe ASTEROID stereotest is a better clinical tool for determining baseline stereopsis and tracking changes during treatment for amblyopia and strabismus compared to current clinical tests.

Plication versus Resection in Horizontal Strabismus Surgery: A Systematic Review with Meta-Analysis.

Purpose The purpose of this review was to compare the efficacy of rectus muscle plication versus resection on the treatment of horizontal strabismus and to evaluate the exodrift after each technique. Methods A research was performed in Latin American and Caribbean Literature on Health Sciences (LILACS); MEDLINE; and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched by 30 June 2019. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search. A minimum mean follow-up of six months was required to access the primary outcomes. Motor alignment success was defined as postprocedure deviation within 10 prism diopters (PD) of orthotropia. Results Seven studies were eligible for inclusion. The grouped success rate after plication was 66% (95% CI = [43%–89%]), and the grouped success rate after resection was 68% (95% CI = [43%–89%]). High heterogeneity was observed between the estimations. There was no difference between the mean amount of deviation corrected in prism diopters, when using the mixed-model approach (SMD = 0.12; 95% CI = −0.2–0.44; p=0.45). The undercorrection rates were also analyzed. The combined odds ratio was 1.37 (95% CI = 0.59–3.16; p=0.462), and there was no statistical significance. Conclusion Plication of horizontal extraocular muscles reveals to be an alternative to resection in strabismus surgery, with similar results. Exodrift is observed after plication and after resection in the treatment of exotropia, but randomized clinical trials are necessary to analyze and compare the follow-up.

Clinical efficacy of the partial rectus muscle transportation procedure for paralytic strabismus.

To analyze the clinical efficacy of the partial rectus muscle transportation (PRT) procedure for paralytic strabismus due to single rectus muscle palsy. In total, 28 patients (31 eyes) who underwent the PRT procedure for paralytic strabismus due to single rectus muscle palsy were retrospectively examined. The following data were collected pre- and postoperatively: angle of deviation in the primary position, presence of diplopia in the primary position, presence of compensatory head posture, and motility of the affected eye. The follow-up period was 6mo. Based on the preoperative and intraoperative findings, different operations were performed: 2 eyes were treated with PRT, 26 eyes were treated with PRT combined with the recession of the antagonist muscle (Am) of the paralytic rectus muscle, and 3 eyes were treated with PRT along with the recession of the Am and the yoke muscle (Ym). On the first day after the operation, 24 patients were found to be orthophoric in the primary position, without diplopia or abnormal head posture. Moreover, 2 patients with monocular lateral rectus muscle palsy had mild overcorrection to 5 prism diopters (PD) and 8 PD, respectively, whereas 2 patients with binocular lateral rectus muscle palsy had mild undercorrection to 8 PD and 10 PD, respectively. During the 6-month follow-up period, the mean deviation was rectified from 96.79±41.21 PD to 0.64±2.38 PD (t=12.48, P<0.001), whereas the deviations in the 2 patients with mild overcorrection were corrected to orthotropia. The mean preoperative limitation of motility improved from -4.55±0.51 to -2.65±0.61 (t=-15.13, P<0.001) after 6mo postoperatively. PRT is an effective treatment for complete paralytic strabismus due to single rectus muscle palsy, and can achieve stable clinical efficacy.

Surgical treatment of strabismus in thyroid eye disease: characteristics, dose–response, and outcomes

To describe the surgical management, dose-response, and postoperative outcomes of strabismus surgery in patients with thyroid eye disease. The medical records of patients operated on between 2014 and 2018 were reviewed retrospectively. Patient characteristics and surgical data were collected. Motor success was defined as vertical deviation of ≤5Δ and horizontal deviation of ≤10Δ; sensory success, as no diplopia in primary gaze. A total of 76 patients (mean age, 62.2±12.9years; 50 females) underwent 87 surgeries, most commonly unilateral inferior rectus recession (unilateral IR, 48%) and bilateral medial rectus recession (bilateral MR, 23%). Motor success was achieved in 69% and sensory success in 58%. For unilateral IR surgery, the dose-responses were 3.25Δ/mm (SE=0.616; β=0.650; P<0.001) at distance and 2.48Δ/mm (SE=0.752; β=0.472; P=0.002) at near; for bilateral MR surgery, 3.93Δ/mm (SE=0.997; β=0.680; P=0.001) at distance and 5.05Δ/mm (SE=1.374; β=0.655; P=0.002) at near. Median (Q1, Q3) postoperative drift was toward overcorrection for both procedures (unilateral IR, -2Δ [-8, 0] at distance and -2Δ [-7, 0] at near; bilateral MR, -2Δ [-8, 2] at distance and -2Δ [-10, 0] at near). Sex, age, duration of strabismus, prior orbital decompression, and concurrent vertical and horizontal procedures were not associated with dose-response or postoperative drift. Concurrent vertical and horizontal surgery did not affect the motor success rate, dose-response, or postoperative drift. Although unilateral IR surgery had a larger dose-response at distance, bilateral MR surgery had a larger dose-response at near. Most procedures tended to have a postoperative drift toward overcorrection.

Paying attention to the application of imaging examination in strabismus

There are many pathogenic factors of strabismus. In addition to the changes of alignment and ocular movement, there may be abnormal pathways and development of extraocular muscles, abnormalities of orbital and intraorbital connective tissue, paralysis of cranial nerves (oculomotor nerve, trochlear nerve, and abductor nerve), and nuclear and supranuclear lesions, accompanied by other cerebral dysplasia sometimes. In recent years, advances in imaging technology and its application in the professional field of strabismus have made it possible to clearly observe the eye, orbital, intracranial, and innervation changes, which is helpful to clarify the etiology of strabismus and extraocular muscle-related diseases, and to provide a basis for the diagnosis and treatment of strabismus. Strabismus specialists should learn and pay attention to the application of imaging examination, so as to achieve in-depth understanding and accurate treatment. (Chin J Ophthalmol, 2020, 56: 166-170).

NGF and CNTF expression and regulation mechanism by miRNA in acute paralytic strabismus.

Nerve growth factor (NGF) and ciliary neurotrophic factor (CNTF) are well-known neurotrophic factors and widely used in the clinical treatment for its promotion effect on peripheral nerve regeneration. And they were also recommended for the acute paralytic strabismus treatment. However, whether the NGF and CNTF have protective effect for the extraocular muscles of acute paralytic strabismus patients is still poorly understood. In this study, we want to evaluate the biological function of NGF and CNTF on the extraocular muscle cells and reveale the regulation mechanism behind it. Firstly, the relative expression of ngf and cntf was assessed by quantitative real-time RT-PCR. Then, the influence of NGF and CNTF on the extraocular muscle cell proliferation was determined by CCK-8. The inflammatory response in muscle cells after NGF and CNTF treatment was evaluated by ELISA and ROS detection. In addition to this, the up-stream regulation of the ngf and cntf expression was also studied. The TargetScan was used for the predication of potential miRNAs targeting with ngf and cntf 30-UTR, which is soon confirmed by luciferase activity assay. all the results in this research indicated that NGF and CNTF could promote the muscle cell proliferation and inhibit the inflammatory levels, then exert protective effect on the muscle cell function. All the results in this research indicated that NGF and CNTF could promote the muscle cell proliferation and inhibit the inflammatory levels, then exert protective effect on the muscle cell function. It was conceivable that let 7-5p was the up-stream regulator of ngf and cntf, and let 7-5p might serve as a potential molecular target for acute paralytic strabismus treatment.

Knowledge and Attitude Toward Strabismus in Western Province, Saudi Arabia.

BackgroundStrabismus is a common eye condition having a potential subsequent impact on the psychological and socioeconomic domains of individuals suffering from strabismus. Therefore, this study aimed to find out the level of knowledge and treatability of strabismus in the western province of Saudi Arabia.MethodsAn observational cross-sectional study was conducted in 2018 among people who live in the western region of Saudi Arabia and were age 16 and above by using an online self-administered questionnaire.ResultsOut of 589 participants, 52.8% reported the correct definition of strabismus. The majority of responders agreed that strabismus is treatable (71.5%). In addition, a statically significant relation was found between knowledge of strabismus treatability and age, gender, work state, and level of education. Most participants were aware of the risk factors and complications of strabismus.ConclusionOur study found that the majority of participants had good knowledge of the definition, treatment, and complications of untreated strabismus. Participant’s age, education level, work state, and income were the main factors found to be significantly associated with knowledge of strabismus treatment options.

Surgical treatment of vertical strabismus. Part 2. Indications, scheduling, methods

Treatment of vertical strabismus will almost inevitably involve surgery when it is associated with hyperfunction of the inferior oblique muscle due to the weakness of vertical fusion (3.0-4.0 ave dptr), the presence of cyclotropy and torsional diplopia. Many operations aimed at weakening the lower oblique muscle have been described. However, they have a number of negative aspects associated with high invasiveness, difficulty of technical implementation due to the need for manipulations in the inaccessible area of the eye in proximity to the optic nerve, macular area, large vessels, as well as long duration of the operation, inability to dosage the result of the operation, low functional results. They are, to a large extent, absent in the operation of anterior transposition in which the neurofibrovascular bundle serves as the axis of rotation of the lower oblique muscle changing the vector of its action and increasing the effectiveness of treatment. Despite all the advantages of that technique, its use is still limited due to the lack of methods for controlling the amount of anterior transposition for the treatment of hyperfunction of the inferior oblique muscle, especially of small degrees.

Surgical treatment of vertical strabismus. Part 1. Classification and diagnostics

Vertical strabismus caused by hyperfunction of the inferior oblique muscle is a common oculomotor disorder. It is found in one third of all patients with strabismus, and in 70% of cases it is combined with esotropia. To date, there is no single approach to determining the degree of hyperfunction of the inferior oblique muscle, and the most common classifications are very subjective and inaccurate. Thus, in connection with the need to understand the severity of the disease, as well as to determine the tactics of treatment and prognosis of the surgical outcomes, it is necessary to standartize the classification of this pathology. The mechanism of action of the inferior oblique muscles of the eye is very complex and depends on the position of the eyeball at the time of their contraction. In addition to horizontal and vertical movements, they provide torsional movement. Any impairment of these muscles leads to the development of not only vertical strabismus, but excyclotropia that reduces the effectiveness of strabismus treatment. To identify all the symptoms associated with hyperfunction of the inferior oblique muscle, taking into account the peculiarities of its triple action, it is necessary to conduct a thorough diagnostic study.

Bupivacaine injection for comitant horizontal strabismus: clinical and radiological results.

To report the outcomes of bupivacaine injection for the treatment of comitant horizontal strabismus and evaluate clinical effectiveness and associated radiological changes. This prospective observational clinical study was conducted on 10 patients with comitant horizontal strabismus of up to 40 prism diopters. Ophthalmologic examinations and three-dimensional orbital magnetic resonance imaging were performed pre and post-injection (at first, third, and 12th months). A 4.5 ml of 0.5% bupivacaine was injected into the extraocular muscle under topical anesthesia using an electromyography in all patients. The mean follow-up time at post bupivacaine injection and mean deviation at primary position were was 17 ± 2 months and 21.3 prism diopters, respectively. The mean changes in ocular alignment, enlargement of the cross-sectional area in the injected muscle, and volumetric enlargement were 7.7 PD, 12%, and 17% at the first year post-injection, respectively. No severe or persistent complication was observed. Ptosis and mydriasis were noted post-injection due to the anesthetic effects of bupivacaine but disappeared within 2 h post-injection. Bupivacaine injection improved eye alignment in small-angle horizontal comitant strabismus, effectively diagnosed with orbital magnetic resonance imaging to evaluate volumetric changes of the extraocular muscles. Further clinical studies with larger numbers of patients should be performed to define optimal dosages, concentration, and application method and dose-response relationship.