A report by the American Academy of Ophthalmology has concluded that extraocular muscle injection of botulinum toxin (BTXA) in children and adults achieves motor alignment comparable with that achieved after eye muscle surgery for nonparalytic, nonrestrictive horizontal strabismus.

Led by Dr Gil Binenbaum, Children’s Hospital of Philadelphia, authors compiled the report from 14 studies, of which five were graded level 2 evidence and nine graded level 3. Four of the grade 2 studies showed successful motor outcomes from surgery in 66-77% of patients, which the authors said was not significantly different to BTXA. However, the fifth study showed 94% success with BTXA vs 72% with surgery.

The authors described higher BTXA success rates of 87-89% among children treated in two muscles in one visit. They also noted that good alignment may require multiple BTXA injections, but it was not yet clear whether BTXA injections produce comparable sensory outcomes to surgery in young children.