Indications for botulinum toxin and bupivacaine injection to extraocular muscle for treating strabismus

Compared to strabismus surgery, extra ocular muscle injection is a safer, more acceptable and less invasive way of treatment, which requires less anesthesia time and results in less pain. Nowadays, botulinum toxin has the most extensive clinical use for reducing muscle strength, especially in cases of small-angle strabismus, post squint surgery care, strabismus after nasal endoscopic surgery. Bupivacaine is able to strengthen muscle, providing treatment for small-angle concomitant strabismus and early paralytic strabismus. Combination injection of bupivacaine and botulinum toxin can be used to treat medium horizontal concomitant strabismus and early-onset paralytic strabismus.(Int Rev Ophthalmol, 2018, 42: 169-174) Key words: extra ocular muscle; botulinum; bupivacaine; strabismus