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Dr. JP
Dr. JP, Ophthalmology, Oculoplastic Surgery
Category: Eye
Satisfied Customers: 28
Experience:  Harvard Medical School, Massachussetts Eye and Ear
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I am 22 years old and I have had severe muscle spasms in my

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I am 22 years old and I have had severe muscle spasms in my extraocular muscles(right eye) for 10 months which occured after eye strain after excessive and prolonged reading which has left having to shut my eyes all day and living in horrible discomfort resulting in severe depression. I do not have a disease or condition and the problem is functional without known cause. Is it possible to inject botox into anyone of the 6 eye muscles? Even though botox is more generally used for strabismus.

It seems to me what you are describing is a condition called convergence insufficiency this can be very crippling condition in some patients causing asthenopia, intermintent diplopia and headache. The treatment first begins with a diagnosis which can be made easily by an ophthalmologist who would have you look at a near vision card and place a prism bar infront of one of your eye and move until you develop double vision. Typically at near patients can over come 30-40 prism diopters of prism but patients with convergence insufficiency can only overcome 10-15 prisms. Treatment is convergence exercises and/or baseout prisms in the glasses. I'm not aware of botox being used and feel this would only worsen your condition. Another thought would be divergence excess but once again a good ophthalmology exam by a specialist in strabismus would sort this out for you easily.





Customer: replied 7 years ago.

No I do not have a condition like this as I have already seen an opthamologist and had this test done and I could do this ok. The problem is in the eye muscle (feels like the superior oblique) and occured after excessive eye strain.The muscle is continually spasming all day and gets so tight I cannot use my eyes at all and moving them about exasperates it. It has already been establised I do not have a common problem and I am not looking for a diagnosis. But I am wondering if it is possible to to stop the spasming with botox? I am functionally blind most of the time with the condition and it is extremelly debilitating. I am just wondering whether this could help as I am getting desperate and would rather lose the eye than live with how it is affecting me.



Has anyone considered the diagnosis of superior oblique myokymia?
Treatment for superior oblique myokymia is: carbamazepine (Tegretol) has been used successfully. Other drugs used with variable success include gabapentin and, recently, memantine. Successful surgery options include superior oblique tenectomy accompanied by inferior oblique myectomy. I seriorsly suggest that a diagnosis be made prior to treatment. Have you had neuroimaging?
Customer are you there? can i help anymore?Laughing
Customer: replied 7 years ago.

I've had an MRI scan which shows nothing wrong and I do not have this condition. I have always been a suffereer of eye strain but 10 months ago I was studying long,intense hours to complete univeresity deadlines. My eye muscles became so strained I could not open them at all. A week later the left eye fully recovered but my right eye did not and it felt like there was a "knot" in the musce. After a month this devloped into severe muscle spasms which got worse through time and which I am still suffering today. The problem is a functional one and is purely down to what I did. The nerves in my eye work fine and my sight is not affected but the muscle is contunally doing this. I already know there is no cure which is why I am wondering whether botox could be tried. I just want to know whether it could be used and whether it is possible to be injected to any of the 6 eye muscles? I just want the spasming to stop, even if it means I use a patch on the eye and just use the good one

I understand you situation now. I have searched the pubmed database and can't find a significant article that utilizes botox for an extraocular muscle spasm. Can you tell me when the episodes occur do they cause the world to move? And if this occurs does it go away when you cover the spasming eye? Have you looked in the mirror and seen what your eye is doing?
Customer: replied 7 years ago.


I have not heard anyone with a case like mine ( I have an over driven personalilty and tend to carry on when my bodies telling me to stop Frown)


The spasming occurs all the time to different degrees and never feels settled or normal. Sometimes I can use my eyes a little bit but this usually starts up a reaction afterwards. Most of the time I can't use them at all and have to shut them to stop them moving and the mucsle feels so tight I physcally cannot use it and this can go on for days making my life unberable. Sometime you can see my eye lids flickering due to the reactions happening in the back of the muscle which feels like electricity and occassionally I get double vision in the eye due to the muscle spasming but you cannot see the eye moving.


Nothing has stopped the spasming which is why I want to know if botox is possible to stop this-even if I have to put a patch on the eye. Do you know if its physcically possible to target each of the 6 eye muscles?


It is possible and would be interesting if it helped. If it worked it would be publishable. Have you an ophthalmologist who would be willing to experiment? I'd recommend a neuro-ophthalmologist. Wish you the best.



Customer: replied 7 years ago.

Not yet lol I am trying to find one but as you can imagine it is difficult as it's something that has not been done before. I am willing for someone to experiment even if it went wrong. I would rather someone this than try nothing. Could you give me any tips on how to get someone to attempt this? And do you know alot about botox in the eye muscles? If you do not is there a doctor on this swebsite who has more expertise in this area?


Thank-you for your help

 I've done botox to extra-ocular muscle several times to induce a ptosis to protect patients corneal surface. It's not that hard to do and feel if a patient is will to try and cosents to the fact that it may not works i'd do it for them. would you like me to find a neuro-ophthalmologist in the area?  if so tell me city and i'll try to find the closet one to you.



Customer: replied 7 years ago.

If only I lived in Americal lol In Britain it is alot harder to get things done and rules seem alot more rigid. I wish I could find someone willing if I am willing to take a risk as it can't get any worse for me! I just want someone to experiment


What is ptosis? And Is it possible if the muscle is at the back of the eye.

? The muscle which is affected is nearest the nose as sometimes I feel as though my nose is being squeezed due to the over whelming tightness in the muscle and this is why I am guessing it's the superior oblique muscle.



Ptosis is when the upper eye lid droops down over the eye surface.

I'm still convinced by what you are saying that you have superior oblique muscle myokymia. This muscle originates in the back of the eye socket and comes anteriorly along side of the medial wall of the orbit near the nose and is know for causing significant problems with pain, spasm and a sense of tightness in the superonasal aspect of the orbit. I wish you well. Is there anything else I can do to help you?



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Customer: replied 7 years ago.

I do not have this as I have seen opthamologists and I have also researched it and the symptoms do not match. It just appears that the problem has occured in this muscle through the severe eye strain.


Thank-you for your help, I will see where I get with the botox