Essential infantile esotropia in neurologically impaired pediatric patients: is botulinum toxin better primary treatment than surgery?

Binocul Vis Strabismus Q. 2007;22(4):221-6.


A prospective study was performed over a 10 year period on 25 children with infantile esotropia and neurological problems to answer this question. From November 1996 to March 2006 they were treated with injections of botulinum toxin (Botox) of both medial rectus extraocular muscles. Mean age was 26.4 months, (range 9-76 months) and mean initial angle was 35 prism diopters (PD)(range 20-60 PD).

Results: 18 patients (72%) remained orthotropic+/-10 PD at 29 months (range 6-59 months). Average number of injection treatments was 1.5 per patient. We compared our success rate data with those obtained with primary conventional strabismus surgical procedures in 2 previously published series. Treatment with botulinum toxin seemed to produce better results than one surgical series and at least equally similar results to the other one. Because there are, as well, so many other advantages to the injection procedure including superior safety and economy, we now use botulinum injections as our primary treatment in these patients.

Publication types

  • Comparative Study

MeSH terms

  • Botulinum Toxins, Type A / therapeutic use*
  • Child
  • Child, Preschool
  • Disabled Children*
  • Esotropia / complications
  • Esotropia / drug therapy*
  • Esotropia / surgery*
  • Humans
  • Infant
  • Injections
  • Nervous System Diseases / complications*
  • Neuromuscular Agents / therapeutic use*
  • Oculomotor Muscles / surgery*
  • Prospective Studies
  • Treatment Outcome
  • Vision, Binocular


  • Neuromuscular Agents
  • Botulinum Toxins, Type A