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Letter to the Editor
Globe perforation during botulinum toxin injection
  1. M MOHAN,
  2. B W FLECK
  1. Department of Ophthalmology, University of Edinburgh, Princess Alexandra Eye Pavilion, Lauriston Place, Edinburgh
  1. Dr Mohan.

https://doi.org/10.1136/bjo.83.4.501d

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    Editor,—Botulinum neurotoxin A, when injected into striated muscle, prevents acetylcholine release causing flaccid paresis of the muscle.1 Scott termed this procedure “chemodenervation” and introduced the technique for treatment of strabismus in 1979.2 The procedure has been reported to be safe with no systemic and minimal local complications. Complications commonly reported following botulinum injection to horizontal muscle are ptosis and vertical muscle involvement.3 We report a case of globe perforation following botulinum injection into the medial rectus muscle in a woman with high myopia.

    CASE REPORT

    A 46 year old woman presented with a 6 year history of diplopia, worse on dextroversion. Prism treatment by her optometrist had partly alleviated her symptoms. She was found to have bilateral abduction weakness, worse on the right side. She was a high myope wearing a −19.5 D lens in her right eye and −17 D in her left eye. She was normotensive, normoglycaemic, and had no neurological abnormalities on clinical examination. A decision was made to perform botulinum injection to her right medial rectus muscle to achieve temporary, or possibly longer lasting, …

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