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Botox For Treating Crossed Eyes

Today, most people know Botox as a cosmetic treatment. The truth, however, is long before its cosmetic benefits were discovered, Botox was initially used to treat strabismus – crossed eye – back in 1980. The treatment is being used today to correct this problem without the need for surgery or other invasive procedures. You will also be happy to know that the Botox treatment is also FDA approved to treat a wide range of medical conditions, among them being strabismus. 

Crossed eyes (strabismus) is a condition where one eye remains turned in a direction that doesn't align with the other eye. Treatment for this condition has often included patching, glasses, medication, surgery and exercise. The condition is caused by the muscles that are involved in controlling eye movement. 

In normal conditions, the 6 muscles work in unison to point both eyes in the same direction. For patients that have strabismus, the muscles do not work together. The eye movement fails to maintain a normal ocular alignment. As a result, strabismus patients experience one of the following problems:

  • Outward turning (exotropia)
  • Inward turning (esotropia)
  • Downward turning (hypotropia)
  • Upward turning (hypertropia)

Most crossed eye problems are caused by abnormalities of the neuromuscular control of eye movement. Researchers believe the condition is caused by control centers in the brain that are still evolving. Rarely doesn't the problem result from actual eye muscle. The condition is hereditary, with approximately 30% of kids with the condition having a family member with strabismus. Strabismus is also associated with the following conditions:

  • Poor vision in one eye
  • Down syndrome
  • Uncorrected refractive errors
  • Brain tumours
  • Neurological problems 
  • Stroke 
  • Head injuries 
  • Cerebral palsy 
  • Hydrocephalus (a congenital disease that causes fluid buildup in the brain)

Can Botox Help 

The use of botulinum toxin in the treatment of strabismus was reported more than four decades ago in 1980. The treatment is believed to be the first use of botulinum toxin in medical treatment. Over the years, the use of Botox injections to treat crossed eyes has become very popular. 

In the treatment, Botox is injected into the muscles surrounding the eyes. The injection targets the overactive muscles. According to numerous studies, the botulinum toxin works by rebalancing the strength of the muscle as well as realigning the eyes. 

The results of the treatment last for three to four months. After the botulinum toxin wears out, it is ejected out of the body and muscle relaxation reverts. There are cases where the results last longer. This is more so when there is a muscle that pulls the eye in the opposite direction. After the injection, the overactive muscle can be stretched. This can lengthen the muscle permanently by adding tissues in the period of toxin paresis. As a result, the condition can be corrected for an extended period without requiring the toxin injections every few months.

The best thing about all the studies done on using Botox in the treatment of crossed eyes is that no serious complications have ever been reported. This is one of the reasons why the Food and Drug Administration approved the treatment for use in adults back in 1989. A year later, in 1990, Health Canada also approved the treatment. 

The Procedure 

A Botox treatment of strabismus has to be done in a doctor's office. In both adults and teenagers, the procedure is carried out in a clinic. The procedure starts with the numbing of the eye using anesthetic drops. Once the target area is numbed, the provider will then inject Botox directly into a target eye muscle. This is done using a special needle that is connected to an EMG (electromyogram). Once the needle is in the right position, a patient is asked to move their eye to allow the muscle to contract. The EMG will pick a signal from contracting muscles, thus allowing the ophthalmologist to identify the correct position. A tiny dose – about 0.1ml – is injected, and the needle is removed after 30 seconds. The pause prior to getting the needle out is meant to reduce the spread of the toxin to the surrounding tissues. 

Children too can benefit from the use of Botox to treat crossed eyes. For children, the procedure is done under general anesthetic or ketamine anesthetic. With ketamine anesthetic, eye muscles remain active, and the EMG can be used to locate the right muscle just as it is done with adult treatments. When the procedure requires the use of a general anesthetic, the provider will make a tiny opening in the conjunctiva next to the muscle. This enables the surgeon to see the muscle that needs to be injected. The opening made is so small that it does not require stitches. 

After the injection is made, the effects will not kick in until after 24 to 48 hours. The patient experiences maximum muscle relaxation after about two weeks. The results will remain for three to four months. After that, the muscle will start regaining normal function. The Botox wears off because the muscle cells will start developing new receptors. As a result, the signalling to the muscle from the nerve will be restored. When this happens, a repeat treatment will be needed. It is good to note that after a repeat treatment, the effects may last longer than four months.

As a child, it was a lot of fun crossing the eyes or twisting the tongue. However, as you grow older, you learn that unless you have full control over these things, it is no longer cool. Strabismus is a condition that is common in children. The good thing is that a treatment is available to manage the condition. While it is a tad bizarre to think of Botox as the solution to strabismus, mostly because it is used to treat wrinkles, you will be amazed by the range of conditions the drug can treat. All you have to do is find the right doctor to perform the treatment. The treatment is completely safe, provided the dosage is administered in a highly controlled and precise dosage. How much dosage is needed will depend on an individual situation. 

Approved Indications for Botox