Treatment of sixth nerve palsy in adults with combined botulinum toxin chemodenervation and surgery.

This study reports the results of treating unrecovered sixth nerve palsy in adults with a combination of botulinum toxin and surgery. Twenty-two adults, 11 with unilateral and 11 with bilateral unrecovered sixth nerve palsy, were treated with injections of botulinum toxin to the contracted medial rectus followed by transposition surgery to the vertical rectus muscles. This management technique produced a satisfactory reduction in esotropia, averaging 46 prism diopters (PD), comparable with that achieved by conventional surgery in other series. The advantages of this form of treatment are discussed.