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Infantile Esotropia - Botulinum Toxin

How is botulinum toxin (Botox) treatment performed and what are the complications of treatment?

Video Transcript:

Botulinum Toxin, more commonly known as botox, injections into the inner muscles of both eyes is an alternative to surgery, that can be used in children from the age of 3 months of age. This treatment is carried out under a short anaesthetic.

The aim of botox treatment is to temporarily weaken the inner muscles of both eyes causing the eyes to drift outwards. As the botox wears off the child’s eyes will then drift to a straight position. At this point three possible outcomes can occur:

  • - The child rediscovers their 3D vision and uses this to help keep their eyes in a straight position and no further treatment is needed.
  • - The child’s eyes continue to drift inwards, but not as far as they had done before botox treatment.
  • - The child’s eyes return to their original in turned position.

In the second and third scenario further botox treatment could be considered. On average 2 botox treatments are required to successfully reduce the angle of the squint.

What are the complications of botox treatment?


  • - Droopy eyelids
    Botox may cause a temporary weakness of the eyelid muscles causing them to become slightly droopy. This may last for up to 2-3 weeks, but fortunately it very rarely affects the child’s vision.
  • - Under correction
    If botox treatment(s) does not permanently reduce the angle of the squint squint surgery can still be carried out.

What happens following surgery or botox treatment?

Following surgery or botox treatment children will be followed up regularly in the orthoptic clinic in order to monitor their vision, ocular alignment and binocular vision. Children will also have periodic spectacle checks to make sure they do not require glasses.

Amblyopia can occasionally develop following surgery and this will require patching treatment.

If the child has a developed some form of binocular vision, there is a good chance they will maintain their good ocular alignment throughout their life. However if their binocular vision is poor, or absent, there is a risk the eyes may eventually drift outwards or inwards. Should this occur, further surgery to straighten the eyes can be undertaken.

40% of children with infantile esotropia require more than one operation during their childhood.