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Br J Ophthalmol 1998;82:67-71 ( January )

Dissociated effects of botulinum toxin chemodenervation on ocular deviation and saccade dynamics in chronic lateral rectus palsy

J F Acheson,a C R Bentley,a b J Shallo-Hoffmann,b M A Grestyb

a Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, b MRC Human Movement and Balance Unit, National Hospital for Neurology and Neurosurgery, London

Correspondence to: Mr J F Acheson, Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG.

Accepted for publication 13 August 1997

AIM---Changes in saccade velocity/amplitude characteristics (main sequence) and attenuation of distance esotropia in response to botulinum toxin (BTX-A) chemodenervation of the antagonist medial rectus were studied in a group of nine patients with chronic lateral rectus palsy.
METHODS---Serial measurements of ocular deviation and infrared oculograms of saccadic eye movements to targets at 5°-20° of lateral gaze were made before injection and at 2, 4, 8, 16, and 20 weeks after injection.
RESULTS---At 2 weeks after injection, the ocular deviation changed by a mean of 34.5 prism dioptres and the 5° and 10° adduction saccades were significantly slowed (p<0.02 Wilcoxon signed rank test). By the second examination, however, the adducting saccade peak velocity had returned to normal while the mean ocular deviation remained significantly changed (p=0.01 Wilcoxon matched pairs). By 20 weeks the mean ocular deviation was not significantly different from that before injection (p=0.14 matched pairs).
CONCLUSIONS---The ocular realignment caused by BTX-A may persist after saccadic function has been restored. This may be because toxin may have a more profound and long lasting effect on the orbital singly innervated fibres which are active tonically at rest to hold gaze whereas there is relative sparing of the additional motor units recruited during fast eye movements.

Keywords: lateral rectus palsy; botulinum toxin; saccades

© 1998 by British Journal of Ophthalmology


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