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The effect on quality of life of long-term botulinum toxin A injections to maintain ocular alignment in adult patients with strabismus
  1. Joanne Hancox,
  2. Shanel Sharma,
  3. Kelly MacKenzie,
  4. Gill Adams
  1. Strabismus and Paediatrics, Moorfields Eye Hospital, City Road, London, UK
  1. Correspondence to Joanne Hancox, Strabismus and Paediatrics, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK; johancox{at}


Background There is considerable evidence to show that strabismus patients report their quality of life (QoL) as lower than normal controls. While the majority of patients with strabismus are treated with surgery there are a number of cases where surgery is not possible and good long-term ocular alignment can be maintained with repeated injections of botulinum toxin.

Methods 65 patients who had undergone over 25 injections of botulinum toxin A for long-term control of their deviation were identified and asked to fill in and return the Adult Strabismus questionnaire (AS-20) to assess their QoL.

Results 46 questionnaires were available for analysis. The mean AS-20 score in our patients compared favourably with that reported for normal controls and was much higher than that reported for patients with strabismus.

Conclusion Long-term injections with botulinum toxin A is a good treatment for maintaining ocular alignment if squint surgery is not indicated and those patients receiving treatment score near the level of normal controls in QoL terms.

  • Quality of life
  • strabismus
  • botulinum toxin
  • muscles
  • child health (paediatrics)
  • cosmesis
  • eye (globe)
  • medical education
  • treatment surgery

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  • Funding This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

  • Competing interests None.

  • Ethics approval Approval provided by Moorfields Eye Hospital Audit Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.