R. Fitzsimons, J. P. Lee and J. Elston, “Treatment of Sixth Nerve Palsy in Adults with Combined Botulinum Toxin Chemodenervation and Surgery,” Ophthalmology, Vol. 95, No. 11, 1988, pp. 1535-1542.

has been cited by the following article:

• TITLE: Usefulness of Botulinum Toxin Type-A in the Treatment of Chronic Sixth Nerve Palsy

  AUTHORS: Lelio Sabetti, Immacolata Greco, Domenico Di Lodovico, Antonio Berarducci

  KEYWORDS: Chronic Acquired VI Nerve Palsy; Botulinum Toxin Type-A

  JOURNAL NAME: Open Journal of Ophthalmology, Vol.2 No.1, February 27, 2012

  ABSTRACT: Purpose: The purpose of the study was to evaluate the efficacy of botulinum toxin type A (BTX-A) injection in patients with acquired VI nerve palsy. Methods: Twenty-eight patients (16 F and 12 M), mean age 36.4 +/-- 17.8 DS; range 10 - 69 years with acquired VI nerve palsy, have been treated with BTX-A injection into the ipsilateral medial rectus, at least 6 months after onset. At 6 months follow up, a paresis and a paralysis, were respectively diagnosed if the affected eye could be actively abducted or not, across the mid-line; a simple horizontal rectus muscle procedure was performed for the paresis whilst for the paralysis, both a horizontal and vertical muscle transportation procedure were required. Results: A gradual physiological recovery of the lateral rectus muscle was observed in 9 (32%) patients (GROUP I) and surgical treatment was therefore unnecessary; the remaining 19 cases (68%), of which 5 paresis (GROUP II) and 14 paralysis (GROUP III) underwent surgery and within 1 year were all restored to orthotropia. Conclusion: Botulinum toxin type-A (BTX-A) injection is an invaluable tool in the differential diagnosis between paresis versus paralysis of the VIth nerve, allowing the correct choice of surgical procedure.