While doctors use Botox to treat upper limb spasticity, involuntary contraction of neck muscles, chronic migraine, and bladder dysfunction in adults, injections of botulinum toxin are an option available for the treatment of strabismus (improper alignment of the eyes) in pediatric patients 12 years old and older. Eye doctors also use botulinum toxin to treat blepharospasm – involuntary blinking or closing of the eyelids.

Although Botox is FDA approved for the treatment of strabismus and blepharospasm, it's important to learn more about how the injections work and what symptoms are a sign of hypersensitivity before deciding on botulinum toxin injections to treat your child's eye problems.

How Treatment Works


Botulinum toxin injections work by relaxing tight muscles. When treating strabismus, the drug is injected into the stronger muscle. By paralyzing the stronger muscle on one side of the eye, the weaker muscle on the other side of the eye strengthens.

Treating the muscles of the eyes with Botox straightens a child's eyes by giving the muscles equal strength. Otherwise, the stronger muscle can pull the eye in the opposite direction, making your child's eyes look misaligned.


Blepharospasm – often referred to as a tick – affects the muscles around the eyes. Although the condition is rare in children, it can cause symptoms similar to those experienced by adults. The condition, which usually occurs in affected children during the first 10 years of life, can progress over time and continue into adulthood.

Abnormal contractions of the eyelid muscles are what cause the involuntary twitching and blinking. Botulinum toxin injections improve the symptoms by temporarily paralyzing these muscles. Injections are given above and below the eye.

Botox treatment is not a cure for either strabismus or blepharospasm, but it can temporarily alleviate symptoms. The effects last for only a few months, after which time, the treatment is repeated.

Potential Hypersensitivity Reactions

Drugs that contain botulinum toxin generally are safe for the treatment of strabismus and blepharospasm when injections are administered at the recommended doses by a skilled eye doctor or other medical professional. But like all medications, there is the risk of possible side effects to consider. Some cases of hypersensitivity reactions have been reported in which patients experienced reactions such as skin rashes, edema (swelling) of soft tissues, and shortness of breath.

In some instances, a mild allergic reaction has occurred, causing fever and joint pain and stiffness. Anaphylactic (severe) allergic reactions to botulinum toxin are rare, but tell the ophthalmologist if your child is allergic to any of the ingredients in Botox, or if he/or she is taking other prescription and/or nonprescription medications that could interact with the drug.

The most common reactions reported when botulinum toxin injections are administered as treatment for eye problems include dry eyes, red, watery eyes, and sensitivity to light. Drooping eyelids and temporary visual disturbances can sometimes occur; however, the risk is reduced if the injections are given by a doctor experienced in giving Botox injections around the eyes. Although side effects that may occur are temporary, inform your child's doctor or eye care professional of any problems following the injections.