Faculty Collaboration Database

Unsatisfactory treatment of acquired nystagmus with retrobulbar injection of botulinum toxin. Am J Ophthalmol 1995 Apr;119(4):489-96

Date

04/01/1995

Pubmed ID

7709974

DOI

10.1016/s0002-9394(14)71236-x

Scopus ID

2-s2.0-0028941866 (requires institutional sign-in at Scopus site)   58 Citations

Abstract

PURPOSE: We quantified the effects of botulinum toxin injected into the retrobulbar space of patients with acquired nystagmus with prominent vertical or torsional components.

METHODS: We measured binocular eye rotations in three planes before and after injection of botulinum toxin (10, 12.5, or 25 units) into the retrobulbar space of one eye of each of three patients, ages 28 to 37 years, with acquired pendular nystagmus.

RESULTS: Retrobulbar injection of botulinum toxin abolished or reduced all components of the nystagmus in the treated eye in all three patients for about two to three months. The patient who received 25 units developed complete external ophthalmoplegia and blepharoptosis. The other two patients retained some voluntary movements but developed diplopia. In one patient, visual acuity improved from Jaeger 5 to Jaeger 1. In a second patient, filamentary keratitis developed, and visual acuity declined from Jaeger 2 to Jaeger 7; keratitis was a recurrent problem one year after the botulinum toxin injection. In the third patient with predominantly torsional nystagmus, visual acuity was unchanged at Jaeger 2. No patient was pleased with the results, because of blepharoptosis, diplopia, or discomfort (from keratitis), and none elected to repeat the procedure.

CONCLUSIONS: The side effects of botulinum toxin administered by retrobulbar injection limit its therapeutic value in the treatment of acquired nystagmus. Even smaller doses that do not abolish nystagmus may produce troublesome diplopia.

Author List

Tomsak RL, Remler BF, Averbuch-Heller L, Chandran M, Leigh RJ

Author

Bernd F. Remler MD Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Blepharoptosis
Botulinum Toxins
Diplopia
Eye Movements
Female
Humans
Injections
Keratitis
Male
Nystagmus, Pathologic
Ophthalmoplegia
Vision, Binocular
Visual Acuity