Issues in the Use of Botulinum Toxin Injections in the Early Management of Cranial Nerve Palsies, Particularly Abducens Palsy

It is recognized that botulinum toxin injections may be used to produce temporary paralysis of injected extraocular muscles and that this treatment may even have long term effects in patients with strabismus or long standing oculomotor palsies. There may be specific circumstances where medical considerations or patient preference favor BT injections over conventional surgical procedures. The specific issue to be discussed in this presentation is whether and/or when to introduce such injections within the first days to six months of the appearance of a presumed neurogenic paralysis of the extraocular muscles, particularly the lateral rectus. To answer these questions we need to consider the differential diagnosis and natural history of abducens palsy in patients who may be candidates for BT injections and the posssible risks and benefits from such intervention.