Management of childhood cyclic esotropia with botulinum toxin.

[PURPOSE] We aimed to describe three cases of childhood cyclic esotropia and report the outcomes of botulinum toxin type A (BTA) treatment.

[MATERIALS AND METHODS] Three children with cyclic esotropia manifesting in a 48-hour cycle were included in the study. BTA (5 IU) was injected into the medial rectus muscles.

[RESULTS] The first patient was a 9-year-old boy with esodeviation (55-50 PD at near and distance) beginning after phacoemulsification surgery for juvenile cataracts. Injection of BTA resulted in breaking the cycle, and a second BTA injection was performed for residual deviation. During the 6-year follow-up, he remained orthophoric with a stereoacuity of 40arcseconds. The second patient was a 9-year-old girl with latent nystagmus and anisometric amblyopia. She experienced diplopia and esotropia (65-45 PD at near and distance). After two BTA injections and 8 years of follow-up, she remained stable with a stereo acuity of 800 arcseconds. The third patient was a 5-year-old boy with a history of falls and right esotropia (40 PD at near and distance). Following a single BTA injection, he was found to be orthophoric with a 4-year follow-up.

[CONCLUSIONS] Based on our cases, BTA injection was found to be an effective method for achieving long-term orthotropia. After breaking the cycle with the first BTA injection, recurrent injections may be useful for residual deviations. We believe that BTA injection should be considered the first-line treatment for cyclic esotropia.