From the Guidelines
Strabismus should be managed by an ophthalmologist with expertise in the diagnosis of longstanding childhood strabismus and abnormalities of binocular function, and treatment options may include eyeglasses, prism lenses, vision therapy, eye patches, and surgery, with the goal of improving motor alignment, sensory recovery, and quality of life. The management of strabismus involves a comprehensive approach, including a detailed sensorimotor evaluation, assessment of refractive status, and dilated fundus examination 1. In cases where the fixation cannot be switched back due to permanent and untreatable vision loss, vision in the newly dominant eye should be optimized with refractive correction and the use of prisms, and strabismus surgery may be an option if there is a significant angle of misalignment and a demonstrated ability to relieve diplopia with prism correction 1. The causes of strabismus in adults are numerous and include recurrent, decompensated, or unresolved childhood strabismus, sensory strabismus, convergence insufficiency, and divergence insufficiency, among others 1. Treatment options for adult strabismus depend on the type and severity of the condition, as well as the patient's age and whether amblyopia is present, and may include chemodenervation, surgical treatment, and orthoptic therapy 1. A multidisciplinary approach may be required, and consultation or comanagement with comprehensive ophthalmology, oculoplastics, neuro-ophthalmology, and other specialties may be necessary, depending on the circumstances of the injury and the timing of the strabismus evaluation 1. Some key principles in the management of strabismus include:
- Attempting to recover "lost" muscles whenever possible
- Using transposition procedures or posterior fixation sutures to expand the field of single binocular vision
- Using adjustable sutures to improve outcomes
- Considering a multidisciplinary approach to management. Overall, the goal of treatment for strabismus is to improve motor alignment, sensory recovery, and quality of life, and to prevent permanent vision problems like loss of depth perception or amblyopia 1.
From the Research
Definition and Prevalence of Strabismus
- Strabismus, or misalignment of the eyes, is a common ophthalmic problem in childhood, affecting 2 to 5% of the preschool population 2
- It is often associated with amblyopia, which is an important cause of visual morbidity 2
Treatment Options for Strabismus
- Pharmacological means for treating strabismus and amblyopia can be divided into 3 categories: paralytic agents, autonomic agents, and centrally acting agents 2
- Botulinum toxin is a paralytic agent that can be used to treat strabismus, particularly in cases with smaller degrees of misalignment and good binocular fusion 2, 3, 4
- Surgery is also a common treatment option for strabismus, with a relatively low risk of complications and a high success rate in achieving satisfactory alignment 5
Efficacy of Botulinum Toxin in Treating Strabismus
- The efficacy of botulinum toxin in treating strabismus is still unclear, with low-certainty evidence suggesting that it may be less effective than surgery in achieving ocular alignment 3, 6
- However, botulinum toxin may be a useful alternative to surgery in certain cases, such as small angle strabismus or strabismus with binocular potential 3, 4
- The use of botulinum toxin in combination with other treatments, such as surgery or adjuvant solutions, may also be effective in achieving ocular alignment 3, 6
Complications and Side Effects of Botulinum Toxin
- Common complications and side effects of botulinum toxin include ptosis, vertical deviation, and transient blurred vision 3, 6
- The risk of these complications can be minimized with proper dosing and technique, as well as careful patient selection 3, 4
Future Directions for Research
- Further high-quality trials are needed to compare the efficacy and safety of botulinum toxin with other treatment options for strabismus, including surgery and conservative therapy 3, 6
- These trials should be rigorously designed and analyze outcome data appropriately to provide evidence of high certainty 6