Tonic pupil after botulinum toxin-A injection for treatment of esotropia in children.


Journal Article

A total of 27 children with esotropia (mean age, 3.9 years; range, 9 months to 13.8 years) were enrolled in a 9-month observational study following botulinum toxin A (BTX-A) injection of one (n = 7) or both (n = 20) medial rectus muscles. BTX-A dosage ranged from 3.0 to 6.0 units per muscle. Three participants developed tonic pupil, noted at the first follow-up visit, occurring 12-19 days after injection. All 3 cases occurred in the left eye of participants who underwent bilateral BTX-A injection by the same surgeon. Anisocoria diminished from a maximum of 4 mm at the 2-week visit to 1-2 mm in all patients over the 9-month postinjection data collection period. No adverse visual outcomes were noted. Tonic pupil is an infrequently reported complication of BTX-A injection for strabismus. The experience of our investigator group suggests the need for careful injection technique and thorough preinjection counseling.

Full Text

Cited Authors

  • Christiansen, SP; Chandler, DL; Lee, KA; Superstein, R; de Alba Campomanes, A; Bothun, ED; Morin, J; Wallace, DK; Kraker, RT

Published Date

  • February 2016

Published In

Volume / Issue

  • 20 / 1

Start / End Page

  • 78 - 81

PubMed ID

  • 26917081

Pubmed Central ID

  • 26917081

Electronic International Standard Serial Number (EISSN)

  • 1528-3933

International Standard Serial Number (ISSN)

  • 1528-3933

Digital Object Identifier (DOI)

  • 10.1016/j.jaapos.2015.09.011


  • eng