Clinical Observation and Therapeutic Efficacy Evaluation of Botulinum Toxin Type A Injection in the Treatment of Abducens Nerve Palsy-Induced Esotropia

DOI: 10.12201/bmr.202606.00064

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  Abstract: AbstractObjective: To investigate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection for the treatment of early-stage esotropia secondary to abducens nerve palsy. Methods: This retrospective study analyzed the clinical data of 52 patients (52 eyes) with abducens nerve palsy-induced esotropia who received BTX-A treatment at the Department of Ophthalmology, Huai''an First Hospital Affiliated to Nanjing Medical University, from August 2023 to February 2025. All patients were followed up for 6 months. Non-parametric statistical tests were used to compare clinical parameters—including the degree of strabismus, orthophoria rate, and grade of ocular motility restriction—at different time points (pre-injection, and 1, 3, and 6 months post-injection). Therapeutic efficacy and its influencing factors were also evaluated. Results: Compared to pre-injection levels, the degree of strabismus was significantly reduced, while the orthophoria rate and ocular motility were significantly improved at 1, 3, and 6 months post-injection (all P<0.001). The median strabismus deviation decreased from 35.0△ pre-injection to 10.0△ at 1 month, 10.0△ at 3 months, and 7.5△ at 6 months. There was no statistically significant difference in deviation between 3 and 6 months post-injection (P>0.05), suggesting that the therapeutic effect stabilized. At the 6-month follow-up, the overall effective rate was 80.77%. Correlation analysis revealed a significant association between the improvement in ocular motility and the achievement of orthophoria (P<0.05). Furthermore, multiple regression analysis identified baseline strabismus deviation and improvement in ocular motility as independent predictors of the magnitude of strabismus correction (P<0.05). An analysis of non-responders showed that their baseline strabismus deviation was significantly greater than that of responders (P<0.001). Conclusion: BTX-A injection is a safe and effective non-surgical option for improving ocular alignment and motility in patients with early-stage abducens nerve palsy-induced esotropia. The therapeutic effect tends to stabilize after 3 months. Patients with a larger initial angle of deviation may have a poorer prognosis.

  Key words: Abducens Nerve Palsy-Induced Paralytic Esotropia; Botulinum Toxin Type A (BTX-A); Treatment; Clinical Parameters

  Submit time: 20 June 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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