Botulinum toxin A as a treatment modality for acute acquired comitant esotropia - An Indian perspective

To analyze the outcomes of botulinum toxin A injection in acute acquired comitant esotropia (AACE).

This is a retrospective study that included cases diagnosed as AACE between January 2022 and February 2023. Patients who were treated with Botox and completed a minimum 3 months follow-up were included in the study. All the patients underwent a complete ophthalmic, orthoptic examination and neuroimaging. The effects of age, onset of esotropia, screen time, deviation pre injection, mode of injection (transconjunctival/ open sky) and whether injection was administered in one/both eyes on successful outcome were analysed.

Twenty-seven patients (20 male, seven female) were included in the study. The median age was 10 years. The median deviation for distance and near preinjection was 35 and 40 prism diopters, respectively. Complete resolution of symptoms was noted in 18 patients (66.6%). Four patients needed prisms, two required repeat injections, and one each needed surgery and divergence therapy. Six patients developed ptosis. None of the risk factors seemed to affect outcomes.

Botulinum toxin injected into the medial rectus is a safe and viable option for AACE. Preinjection counseling about ptosis, recurrence needing prisms, reinjection, or surgery is important.