title: The efficacy of botulinum toxin treatment for children with a persistent esotropia following bilateral medial rectus recessions and lateral rectus resections.
abstract: OBJECTIVE
  To report on the outcomes of treating children with a persistent esotropia with an injection of botulinum toxin in a medial rectus muscle.
  
  
  METHODS
  The medical records were reviewed of all children at one institution with a persistent esotropia after bilateral medial rectus recessions and bilateral lateral rectus resections then treated with a botulinum toxin injection.
  
  
  RESULTS
  Five patients with a mean preoperative esotropia of 37Δ (range 25–50Δ) underwent bilateral medial rectus recessions and then bilateral lateral rectus resections. Their residual esotropia (mean of 25Δ; range 18–35Δ) was then treated with a single injection of 3–5 units of botulinum toxin into one medial rectus muscle. The patients were then followed for a mean of 34 months (range 14–79 months). At last follow-up, two patients had an esotropia <10Δ. The other three patients had no long-term improvement in their ocular alignment. Two of these patients then underwent additional strabismus surgery. In both cases, they then developed a consecutive exotropia.
  
  
  CONCLUSIONS
  Treatment with a single injection of botulinum toxin was beneficial in 2 of 5 children. Botulinum toxin treatment alone did not result in a consecutive exotropia in any patients treated.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Lambert
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Shainberg
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002648:Child; D004948:Esotropia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005133:Eye Movements; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins