Botox works by causing a temporary large overcorrection [lasts several weeks] to produce a small permanent change.

Surgery realigns the eye[s] by shifting muscles around and there is usually little/ no change to the alignment once everything settles.

20 years after Botox was developed in the hope that it would replace strabismus surgery, there has still been no prospective randomised trial in strabismus!

Dr. Kowal has been using Botox for strabismus and facial spasms since the late '80s, and believes that for small-moderate angle esotropia the results of strabismus and Botox are comparable.