Botulinum Toxin A Treatment of Consecutive Esotropia in Children

Objective: To assess the outcome of botulinum A toxin (BTXA) to treat surgically overcorrected intermittent exotropia in children. Methods: A retrospective analysis was performed on a series of children with consecutive esotropia treated with BTXA. Results: Six children with a mean consecutive esotropia of 21 prism diopters (PD) were treated with BTXA at a mean of 19.8 months following strabismus surgery. Two patients underwent a single injection, three patients 2 injections, and one patient 3 injections. Complications included transient ptosis and a vertical deviation. Mean follow-up from last BTXA injection was 16 months. At last follow-up, 4 of the 6 patients were orthotropic and stereopsis was present in 4 of 5 patients old enough to cooperate with testing. One patient was treated with strabismus surgery following a single BTXA injection. Conclusions: BTXA is an efficacious treatment for consecutive esotropia in children. However, in our series, two-thirds of patients required multiple injections to achieve the desired outcome and one ultimately had an additional strabismus surgery.