The effect on quality of life of long-term botulinum toxin A injections to maintain ocular alignment in adult patients with strabismus

Br J Ophthalmol. 2012 Jun;96(6):838-40. doi: 10.1136/bjophthalmol-2011-301332. Epub 2012 Feb 24.


Background: There is considerable evidence to show that strabismus patients report their quality of life (QoL) as lower than normal controls. While the majority of patients with strabismus are treated with surgery there are a number of cases where surgery is not possible and good long-term ocular alignment can be maintained with repeated injections of botulinum toxin.

Methods: 65 patients who had undergone over 25 injections of botulinum toxin A for long-term control of their deviation were identified and asked to fill in and return the Adult Strabismus questionnaire (AS-20) to assess their QoL.

Results: 46 questionnaires were available for analysis. The mean AS-20 score in our patients compared favourably with that reported for normal controls and was much higher than that reported for patients with strabismus.

Conclusion: Long-term injections with botulinum toxin A is a good treatment for maintaining ocular alignment if squint surgery is not indicated and those patients receiving treatment score near the level of normal controls in QoL terms.

MeSH terms

  • Botulinum Toxins, Type A / therapeutic use*
  • Female
  • Humans
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Neuromuscular Agents / therapeutic use*
  • Oculomotor Muscles / drug effects*
  • Quality of Life / psychology*
  • Strabismus / drug therapy*
  • Strabismus / psychology*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Vision, Binocular / physiology


  • Neuromuscular Agents
  • Botulinum Toxins, Type A