Purpose: To perform a systematic review of the application of
botulinum toxin A (BTA) in the management of
strabismus in the adult and pediatric populations. Materials and methods: A systematic literature search was performed using the Medline database. Results: In 1989, with the FDA approval of
botulinum toxin (
onabotulinum toxin A, or BTA) for the treatment of
strabismus, patients were provided with an alternative to surgical recession. In this review, we discuss the uses of BTA in the treatment of acute onset comitant
esotropia or smaller angle
esotropia and as an adjunct to surgery for larger angle
esotropia or
sixth nerve palsy. Its uses are also explored in intermittent
exotropia and vertical
strabismus, including thyroid-associated orbitopathy,
fourth nerve palsies, and other orbital pathology. Discussion: Despite its transient kinetics, BTA can have permanent effects on ocular alignment, promoting binocularity and reduction of
diplopia, and can serve as a primary treatment or a muscle sparing option in patients at risk of anterior segment
ischemia or need for future surgeries.