Clinical outcomes of botulinum toxin injection in patients with cerebral palsy and esotropia

Strabismus. 2015;23(1):8-13. doi: 10.3109/09273972.2014.999798. Epub 2015 Mar 19.


Purpose: To assess the efficacy of botulinum toxin (Novotox) injection in patients with cerebral palsy (CP) and esotropia.

Patients and methods: In a non-comparative, prospective interventional case series botulinum toxin injection was done in 44 patients with CP and esotropia. A single dose of botulinum toxin was injected in both medial rectus muscles of all patients and was repeated in 12 patients. Angle of deviation within 10 prism diopters (PD) of orthotropia was defined as a successful outcome.

Result: Forty-four patients (21 males) with the mean age of 47.56 ± 35.86 months were included in the study. The mean esotropia in all patients was 52.27 ± 18.40 PD (25-123 PD). The range of follow-up was 12-24 months. Thirty patients (68.18%) were treated successfully one year after surgery. The rates of success, consecutive exotropia, and residual esotropia were 61.4%, 13.63%, and 25% in the last follow-up, respectively. The logistic regression showed statistically significant results between success result and lower age, higher pre-injection deviation, one month post-injection deviation, and severe ptosis. Complications included subconjunctival hemorrhage and ptosis.

Conclusion: Botulinum toxin injection is reasonably less invasive with light anesthesia, scar free, and a therapeutic alternative for the patient with esotropia and CP. Therefore, it can provide more possible surgical options in future.

Keywords: Botulinum toxin; cerebral palsy; esotropia.

Publication types

  • Clinical Study

MeSH terms

  • Botulinum Toxins, Type A / administration & dosage*
  • Cerebral Palsy / complications
  • Cerebral Palsy / drug therapy*
  • Child
  • Child, Preschool
  • Esotropia / diagnosis
  • Esotropia / drug therapy*
  • Esotropia / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Injections, Intramuscular
  • Male
  • Neuromuscular Agents / administration & dosage*
  • Oculomotor Muscles / drug effects*
  • Prospective Studies
  • Treatment Outcome


  • Neuromuscular Agents
  • Botulinum Toxins, Type A