Fig. 3 Patient ready for botulinum A toxin extraocular muscle injection. Note the placement of the electrocardiographic electrode on the patient's forehead medially for a medial rectus muscle injection. The patient is in the supine position and the head is supported comfortably on a pillow. A tray, table, or other support is necessary for the audio electromyographic device since the electrode wires are only 24 inches long.