Am Orthopt J   45: 126-131  (1995)

Permanent Sixth Nerve Paralysis in Infantile Botulism

Earl R. Crouch, Jr., M.D., Kathryn Goodrich-Snyder, C.O., M.Ed., and Paul Cunningham, M.D.

Infantile botulism, first described in 1976, is caused by ingestion of live C. Botulinum organisms or spores which subsequently release toxin in the intestine. This paper will discuss infantile botulism and how during a critical period for visual development, this disease can interfere with the development of normal binocular vision, setting into motion a variety of ocular motor abnormalities.

The diagnosis of infantile botulism in our patient was confirmed by stool assay for Clostridium botulinum toxin by the Center for Disease Control, Atlanta. The patient developed infantile botulism with resultant unresponsiveness and generalized weakness. Respiratory arrest required intubation and mechanical ventilation. Total ophthalmoplegia occurred. Within six weeks of total ophthalmoplegia, the patient had complete return of extraocular function with the exception of the lateral rectus muscles. Four months post-treatment, abduction had fully returned, however, a large angle of esotropia remained and overacting inferior oblique muscles developed. Infantile esotropia is an eye condition which develops several months after birth and results in a variety of perceptual and ocular motor abnormalities. Our patient experienced a disruption of the development of normal ocular alignment and binocularity during a critical period of visual development. She developed many ocular motor abnormalities characteristic of infantile esotropia.

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