In the case presented a Botulinum toxin was injected into the extraocular muscles to treat limitation of eyeball movement due to retention of a metallic foreign body in the orbit. A 32-year-old man had had a major complaint of exohypotropia with diplopia for 15 years and a routine X-ray examination and C-T scan of the orbit revealed an approximately 5 cm-long metallic foreign body bridging the right retrobulbar space, the right ethmoid sinus and the sphenoid sinus. During the course of extracting the foreign body, a lesion on the muscle, fatty tissue and fibrotic adhesion, resulting in disuse atrophy or mechanical damage of the right medial rectus and right superior rectus appeared likely. The injection of 5 units of Botulinum toxin into both the right lateral rectus and the right inferier rectus appeared clinically successful after 6 months, resulting in orthophioria and dimining diplopia.
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