BOTOX vs. SURGERY FOR SMALL / MODERATE ANGLE ESOTROPIA
(12/03)
BOTOX works by causing a temporary large overcorrection [lasts several weeks] to produce a small permanent change. SURGERY realigns the eye[s] by shifting muscles around and there is usually little/ no change to the alignment once everything settles.
| CRITERION | BOTOX | SURGERY |
| Reliability | ||
| 1 Treatment | 50+% | 80-90% |
| 2 Treatments | ? 60-70% | |
| Usual outcome | 5-10º shift | as needed |
| Investment | ||
| Time | 30 minutes | anesthesia. |
| Walk in / walk out | 24 h in hospital | |
| Eye pad 2 hours | 1 week off work | |
| Surgeon time | 5 minutes | 45 minutes to 2 hrs+ |
| $ | $300 per Rx | no insurance: $3K + |
| Insurance: $1-2K | ||
| Need for 2nd Rx | 50% | 10-20% |
| Inadequate result | ||
| Improved by | Botox & / or surgery | Botox & / or surgery |
| Complications | droopy lid 15% | uncommon |
| Acquired vertical 15% | ||
| 99% recovery for both |
EDUCATIONAL UPDATE
SEPTEMBER 2003
20 years after Botox was developed in the hope that it would replace strabismus surgery, there has still been no prospective randomised trial in strabismus!
Dr. Kowal has been using Botox for strabismus and facial spasms since the late '80s, and believes that for small-moderate angle esotropia the results of strabismus and Botox are comparable.