Transient superior oblique paresis after injection of Botulinum Toxin A for facial rejuvenation

• Published in: Indian journal of ophthalmology Vol. 60; no. 1; pp. 77 - 78
• Main Authors: Kothari, Mihir, Shukri, Najeeha, Quayyum, Abdul
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2012; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - adverse effects; Complications and side effects; Diagnosis; Diplopia - etiology; Diplopia - physiopathology; Eye Movements - drug effects; Follow-Up Studies; Humans; Injections, Intramuscular; Letters to the Editor; Male; Medical imaging; Middle Aged; Motility; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - adverse effects; Oculomotor Muscles - drug effects; Oculomotor Muscles - physiopathology; Paralysis; Rhytidoplasty - adverse effects; Rhytidoplasty - methods; Risk factors; Trochlear Nerve Diseases - chemically induced; Trochlear Nerve Diseases - complications; Trochlear Nerve Diseases - physiopathology; Vision, Binocular - drug effects; India
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/0301-4738.90496

Typical complaints, pattern of ocular motility disturbances, history of BTX injection prior to the onset of symptoms and the self-limiting nature of the disease in this patient indicate transient superior oblique paresis due to BTX. Potential risk factors in this patient were inherent susceptibility (causing higher intraorbital diffusion), proximity of the needle tip to the trochlea (faulty technique), deep penetration of the needle into the orbital septum (faulty technique) and increased diffusion of the drug following repeated injections.