Jm. Holmes et al., Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis, J AAPOS, 4(3), 2000, pp. 145-149
Purpose: Botulinum toxin (BTX), injected into the ipsilateral medial rectus
muscle, has been advocated for the management of acute traumatic sixth ner
ve palsy or paresis. We conducted a multicenter, nonrandomized, data collec
tion study to evaluate recovery rates of patients treated with either conse
rvative measures or BTX. Methods: All members of the American Association f
or Pediatric Ophthalmology and Strabismus and the North American Neuro-Opht
halmology Society were invited to enroll patients with acute traumatic sixt
h nerve palsy or paresis during a 2-year period (between March 1996 and Feb
ruary 1998), The BTX group was defined as patients who received a BTX injec
tion within 3 months of injury. Recovery at 6 months from injury was define
d as absence of diplopia in the primary position and a distance esotropia o
f no more than 10 PD in the primary position. Nonrecovered patients with le
ss than 6 months of follow-up (n = 15) were excluded. Results: Eighty-four
eligible patients were enrolled by 46 investigators. Sixty-two patients (74
%) were treated conservatively and 22 (26%) with BTX. Sixty-two patients (7
4%) had unilateral palsy, and 22 (26%) had bilateral palsy. Recovery rates
were similar between BTX and conservatively treated patients (overall: 73%
vs 71%, P = 1.0; unilateral: 81% vs 83%, P = 1.0; bilateral: 50% vs 38%, P
= 0.66, respectively). Conclusions: In this prospective multicenter study o
f acute traumatic sixth nerve palsy or paresis, patients treated with eithe
r BTX or conservative measures had similar high recovery rates.