Botox and 4th Nerve Palsy

With 4th cranial nerve palsy, can Botox be used (although surgery is a better option)?


Thank you!!

[Sandra M Brown, MD]

Usually not.  The Botox would have to be injected into the inferior oblique muscle on the same eye as the palsy, or into the inferior rectus on the opposite eye as the palsy.  The inferior oblique is pretty hard to get to without cutting through the skin of the eye.  

If the palsy is mild and likely to recover, the Botox may last longer than the palsy and then you have given yourself another problem.  If the palsy is permanent, Botox injections will need to be repeated.

If the palsy is mild, prism in glasses may be sufficient to control double vision symptoms.

You should see a pediatric ophthalmologist.  Find one near you at www.aapos.org.