It is now over 20 years since Dr Alan Scott first introduced botulinum toxin type A for the treatment of strabismus. It is now widely used in die treatment of blepharospasm and some hypertonic neuromuscular disorders. "BOTOX" is frequently used by ophthalmologists and plastic surgeons for die cosmetic treatment of facial wrinkles. The role of this agent in die management of strabismus is not cleariy defined. After the initial endiusiasm with this treatment during the investigational period when many different types of strabismus were treated, indications for use of the toxin have narrowed. I believe botulinum would be used more often if the busy strabismologist took the time to consider its use in many of the patients seen. It is highly effective in managing patients with diplopia and has the potential for salvageable binocularity. I must admit diat my indications for use have been limited to injecting the medial rectus muscle in patients with abducens nerve palsy or paresis.
The review article by Drs McNeer, Tucker, and Spencer remind us of the usefulness of this toxin in die treatment of infantile esotropia. It is of interest that there is significant use of botulinum in Europe as the audiors describe so well. Perhaps this is a less invasive alternative for those who like to intervene in infantile esotropia with surgery prior to 6 months of age. Another point addressed by die audiors wordi mentioning is die use of the toxin in-die always difficult to treat-small angle esotropia (<15 prism diopters). Certainly this article provides some information for us to consider if not for die first time, at least in a new way.