Long-term outcomes of botulinum toxin A for acute acquired comitant esotropia in children: a retrospective case series.

[PURPOSE] To evaluate the long-term efficacy of botulinum toxin A (BoNT-A) in children with acute acquired comitant esotropia (AACE).

[METHODS] This retrospective study included pediatric patients treated with BoNT-A for AACE between January 2021 and September 2024. Deviation angles at near (40 cm) and distance (5 m) were recorded before treatment and at 1, 3, 6, 12 months, and final follow-up. Outcomes were categorized as successful (≤10 prism diopters [PD]), partially successful (11-20 PD), or unsuccessful ( >20 PD).

[RESULTS] Twenty patients (mean age 5 ± 1 years; 65% female) were included. BoNT-A was administered a mean of 4 ± 2 weeks after symptom onset. A second injection was required in 35% of patients. At final follow-up (mean: 20.4 ± 12.0 months), mean near and distance deviations were 8 ± 17 PD and 10 ± 17 PD, respectively. Thirteen patients (65%) had successful outcomes, four (20%) were partially successful, and three (15%) were unsuccessful. Patients receiving a single injection had significantly better outcomes than those requiring a second ( = .041). Mild, self-resolving ptosis occurred in two cases (10%).

[CONCLUSION] Early treatment with BoNT-A provides a high rate of motor alignment in pediatric AACE and may reduce the need for surgery. These results support its use as an effective first-line treatment option.