An interventional study of Botox injection into extraocular muscles in Strabismic Deviation and Strabismus, sponsored by Foundation University Islamabad. Not yet recruiting at 1 site in Pakistan. Open to participants aged 1 Month and older. Per ClinicalTrials.gov, last updated 2025-09-18.
Sponsored by Foundation University Islamabad · Not applicable, Interventional, and Treatment
The bacterial species Clostridium botulinum produces a class of neurotoxins known as botulinum toxin. At the neuromuscular junction, botulinum toxin A prevents acetylcholine from being released. Following a Botox intramuscular injection, the injected EOM becomes paralysed 2-4 days after the injection and remains so clinically for at least 5-8 weeks. Muscle function recovery takes five to fourteen weeks, depending on the injection site, volume, and concentration of the solution, as well as the innervation density.
Botulinum toxin treatment results in a pharmacologic recession of the injected extraocular muscle, and the muscle lengthens while its agonist contracts, paralysing it. Improved ocular alignment or a decrease in the severity of the deviation may last for a long time, even if the pharmaceutical impact normally goes away after three months.
Even after the pharmacologic effect has worn off, a number of elements, such as mechanical, proprioceptive, and binocular effects, may intervene during the period of muscle paralysis to help stabilise and improve alignment in strabismus patients over the long term.
Detailed Description: A Strabismus or squint is an ocular condition characterized by misalignment of the eyes. It derived from the Greek word "strabismos" meaning 'to look obliquely'. It can be categorized as congenital or acquired, based on onset; by direction; as concomitant or incomitant/paralytic; and as isolated or syndromic. The prevalence of strabismus in the general population ranges from 2-5%, with a lower prevalence of 0.6% observed in the Asian population.
Normal ocular alignment depends upon the integrity of the extraocular muscles, orbital connective tissues, cranial nerves supplying these muscles, fusion centers, and the visual cortex. The etiopathogenesis of strabismus involves abnormalities in binocular vision or neuromuscular control of ocular motility. Left untreated and unrecognized, strabismus can result in irreversible visual impairment, amblyopia, and abnormalities with binocular vision. Moreover, it can significantly impact the affected individual's personality and lead to undesirable cosmetic concerns, such as misdirected eyes, abnormal facial and head posture, and occasionally, peculiar eye movements like up-shoots or down-shoots. It also has psychosocial implications for those affected by it.
The standard therapy for strabismus is either correction of the refractive errors causing it or strabismus surgery under general anesthesia in our country. For optimal benefit, adjustable strabismus surgery is done for cooperative children and adults. This requires 4-6 hours for the general anesthesia to be worn off and may not be an option for very small children and babies, for whom optimal results may not be obtained, in addition to long general anesthesia time.
For more than thirty years, botulinum toxin A has been utilised as a pharmaceutical treatment for strabismus. The majority of the literature on strabismus views it primarily as a surgical substitute, contingent on the strabismologist's preference. But as time and experience have shown, Botulinum toxin is not just an alternate treatment; it also has some other indications in which surgery is not a smart choice. Although there are few randomised controlled trials, Botulinum toxin appears to work similarly to surgery for certain motility issues. Botulinum toxin produces a "chemodenervation" effect, inhibits the release of acetylcholine, and tampers with calcium metabolism. The paralytic effect lasts for two months after injection into an EOM, with the maximal effect occurring in five to seven days. BTXA's overall weakening impact lasts for six to nine months. It is anticipated that the antagonist will experience a relative contraction when under the influence of Botulinum toxin.
Although Botulinum toxin has a short-term impact on extraocular muscles (EOM), it may lead to a long-term reduction in deviation. Potential explanations for this long-lasting effect could include changes in the number of sarcomeres during its effect, immunohistochemical modifications, and central adaptive mechanisms that show up as better binocularity.
The primary goal of this study is to examine the efficacy and outcomes of botulinum toxin intramuscular injection therapy in the treatment of pediatric or adult strabismus, instead of performing surgery in these patients.
Our plan to use the Botulinum toxin in various doses by injecting it into the overacting extraocular musces in strabismus patients, especially pediatric, but also adult cases, to use it as an alternative for strabismus surgery. For children, it will be administered under sedation or general anesthesia and in adults, under topical anesthesia under sterile aseptic techniques. The preoperative and postoperative measurements of the type of strabismus, patterns, deviation, and post-operative results will be studied both in the short and long-term.
142 studies on the registry are indexed under Strabismus; 31 are open to participants now.
This study's planned enrollment of 127 is above the median of 60 across 82 interventional studies indexed under Strabismus.
Browse Strabismus studies →Foundation University Islamabad is the lead sponsor of 255 studies on the registry; 142 are open to participants now.
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Esotropia or exotropia presenting with a small-to-moderate angle deviation (\<40 PD)
Exclusion Criteria:
Unrealistic expectations
The primary objective is to examine the efficacy and outcomes of Botox (botulinum toxin) intramuscular injection therapy in the treatment of pediatric or adult strabismus
Drug: Botox injection into extraocular muscles
Botulinum toxin in various doses by injecting it into the overacting extraocular musces in strabismus patients, especially pediatric, but also adult cases, to use it as an alternative for strabismus surgery. For children, it will be administered under sedation or general anesthesia and in adults, under topical anesthesia. The pre-operative measurements of the type of strabismus, patterns, deviation, and post-operative results will be studied both in the short and long-term.
Change in Strabismus Angle in Prism Diopters (PD) in the Primary Position from the baseline angle at Week 2, Week 6, 3 months, 6 months, 9 months, and 1 year of the first intramuscular botox injection.
Using the prism cover test (PCT), the strabismus angle in the primary position was determined. The mean of the strabismus angle when viewed from a distance of 6 meters and when viewed from a distance of 33 centimetres was used to calculate the strabismus angle. The same afflicted eye (either the left or the right) was used for each participant's examination for the course of the trial. The difference between the values at Week 2, Week 6, 3 months, 6 months, 9 months, and 1 year and baseline, was used to compute the change from Baseline.
Time frame: Baseline, at 2 weeks post injection, to 1 year post injection
Plan to share: Undecided — the data may be made available in the public repository, or on request from PI
Start is estimated for Sep 2025; primary completion for Aug 2030, 59 months later.
Of 35 non-industry interventional studies with no phase under Strabismus, half reached primary completion within 17 months of starting (the median), counting those still running; a quarter within 8 and three quarters within 46. This study's planned 59 months is above that.
Counting every sponsor, half of 35 studies reached it within 17 months; a quarter within 8 and three quarters within 46.
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This study is not yet recruiting, as verified in Sep 2025. You cannot join it, but the record below documents what was studied.
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