Emerging treatments
Bupivacaine
This local anesthetic has shown promise as a pharmaceutical agent with the ability to increase extraocular muscle strength. Following the injection of bupivacaine into the lateral rectus muscle in the treatment of esotropia, a temporary paresis of the muscle was observed. Over the next month, the muscle regained its strength and an increase in muscle size was documented on MRI. The ocular alignment improved, and the esotropia was treated successfully.[41] Several small, observational studies have indicated some success with single bupivacaine and combined bupivacaine and onabotulinumtoxinA injection.[42][43][44] Although still experimental, this treatment approach is promising.
Use of this content is subject to our disclaimer