Botulinium Toxin is a neurotoxin that normally gets used by plastic surgeons for re-juvenation purposes. [4]

The toxin (or: poison) is produced by the Clostridium botulinum bacteria. As a fun fact: It's the same toxin that causes a life-threatening type of food poisoning called botulism. [5]

In 1980 Botox got first used for improvements in strabismus. [6]

The treatment of Botox primarily serves as an alternative to surgery for adults.

Step-By-Step: How Does Botox Work?

1. Botulinum toxin gets injected into the facial muscles. For lazy eye, it gets injected in the eye muscle.
2. The toxin works by blocking the release of acetylcholine, thereby blocking the nerve impulse.
3. The given eye muscle can’t contract, resulting in (temporary) paralysis.
4. The paralysis of the given muscle – and therefore the changes of eye angle due to the Botox injection - resolves over time (usually 2-3 months).
5. The Botox injection needs to be repeated if the result was desirable.

To make a decision whether or not to go for Botox, it is important to be aware of the pros and the cons. In this section, we'll talk about the side effects, success rate and the cost involved with Botox injections:

Does Botox Work To Treat Strabismus?

Botox in infantile esotropia (kids with eyes turn inward) has a success rate of 76%. [7] The success rate may be lower in adults, as kids tend to respond better to surgery than adults (because chances of stereopsis are higher).

Keep in mind that the success rate considers a deviation of under 10PD (measure of how aligned the eyes are). Other studies show that for long-term alignment and stereopsis potential, an alignment of 4PD or less is required. [8]

So the true long-term success rate may be significantly lower.

Are There Any Botox Side Effects?

Yes, as with any medical procedure, there are potential side effects associated with Botox injections for lazy eye.

While serious complications are rare, the most common side effects are temporary and may include:

1. Bruising or bleeding at the injection site (does Botox hurt? Yes.)
2. Swelling or redness at the injection site
3. Double vision
4. Headache
5. Drooping of the eyelid (ptosis)

Due to the rather common complication of ptosis (27% of all botox injections) - Botox is not recommended for children. [9]

Droopy eyelids look like this:

While I don't know the exact medical history of the Amazon founder and billionaire Jeff Bezos, it does seem like his right eye has slight ptosis (droopy eyelid).

Why Does A Droopy Eyelid Happen?

The Botox might leak into the 'levator palpebral superioris muscle' (the muscle responsible for elevating the eyelid). This resulting in a droopy upper lid (ptosis). [10]

It is important to note that Botox injections for lazy eye should only be administered by a qualified and experienced medical professional, such as an ophthalmologist or a neurologist (not a plastic surgeon - and certainly not on 'Botox parties'!).

Can A Droopy Eyelid Be Fixed?

The droopy eyelid after botox injections should largely subside after a few months. If not, the eyelid can be aesthetically improved with reconstructive surgery.

The reconstructive surgery fixes the eyelid by cutting off a certain part of the eyelid muscle - in doing so, it works similar to strabismus surgery. [11]

How long does Botox last the first time?

The duration of the effects of Botox injections for lazy eye can vary from person to person. During the first treatment for lazy eye with Botox injections, the duration of the effects may be shorter than subsequent treatments.

Typically, the treatment lasts 2-3 months. On a yearly basis, Botox needs to be injected 4-6 times.

How Much Does Botox Cost?

$300 to $400 per injection (done every 2-3 months). Totally an on-going investment of $1,200 per year.

It's important to note that this is a rough estimate, and the cost can vary depending on several factors, including the location, the provider's experience, and the number of injections required. Cost can go up to $800+ per treatment.

Does Insurance Cover Botox Injections?

Generally speaking, no. Most health insurance plans do not cover the cost of Botox injections for cosmetic purposes, including lazy eye treatment. However, in some cases, insurance may cover the cost of Botox injections for medical purposes, such as for treating strabismus (crossed eyes) or blepharospasm (eyelid twitching).

I would not recommend Botox for treating a lazy eye.

• The complication rate is currently too high in comparison to surgery (1 in 3 get ptosis). And over the long-term, it is equally (if not more) expensive than surgery.
• The success rate is good, but not as high as surgery.

As a verdict: The benefits are not worth the risk.

Typically, this sentiment is quite widespread in the strabismus community:

If you're looking to fix your lazy eye but you are not yet ready for surgery, then the best alternative to get started might be our artificial intelligence software:

Lazyeyefix Ai For Improving Strabismus

Our AI software can be downloaded on any Mac or Windows PC - and helps you to analyze and improve your eye movement throughout the day.

It works wonderful with other vision therapy tools, but can also be used as a standalone application.

You can imagine Lazyeyefix Ai as a new, revolutioary, cost-effective, (almost) effort-free tool that should be part of any strabismics rolodex.

You can test out Lazyeyefix by downloading a free trial here:

Mac: https://dashboard.lazyeyefix.com/download/m/

Windows: https://dashboard.lazyeyefix.com/download/w/

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