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Outcome of Botox Injection in Partially Accommodative Esotropia Compared to Medial Rectus Recession
Ghufran Alarfaj1, Abdulmajeed Alkharashi1, Munirah Z Aldofyan1
1Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Clinical Ophthalmology (Auckland, N.Z.)
|June 18, 2026
Summary
Bilateral medial rectus recession surgery shows higher initial success for partially accommodative esotropia (PAET) than botulinum toxin (BTX) injections. Repeated BTX treatments achieve similar long-term results, but surgery offers better primary outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Partially accommodative esotropia (PAET) is a common form of childhood strabismus.
- Treatment options for PAET include surgical intervention and non-surgical approaches.
Purpose of the Study:
- To compare the effectiveness of botulinum toxin (BTX) injection versus bilateral medial rectus recession (BMR) surgery for treating PAET.
- To evaluate primary and cumulative success rates and complication profiles of both treatment modalities.
Main Methods:
- Retrospective review of 107 children under 15 years old treated for PAET between 2015 and 2022.
- PAET defined as residual esotropia ≥ 14 PD after cycloplegic refraction.
- Primary success: ≤ 10 PD alignment after one treatment; Secondary success: alignment after repeat interventions.
Main Results:
- BMR surgery achieved a higher primary success rate (83.9%) compared to BTX injection (50.9%).
- Cumulative success rates after repeat interventions were comparable: 87.5% for surgery and 78.4% for BTX.
- BTX group had a higher rate of subsequent surgery (11.7%); complication rates were similar (BTX 4.8%, surgery 3.57%).
Conclusions:
- Bilateral medial rectus recession surgery offers superior primary success rates for PAET compared to a single BTX injection.
- Repeated BTX injections can lead to comparable long-term success but may require multiple treatments.
- BTX is less invasive with shorter anesthesia, but potential need for repeat sessions should be discussed.
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