Botox for Eye Alignment: A Gentler Option for Treating Strabismus

When most people hear “Botox,” they think of wrinkles. But did you know Botox was first developed to help with eye misalignment (strabismus)? Today, Botox (botulinum toxin) is not just used in cosmetic medicine. It’s also an effective, less invasive treatment option for some children and adults with strabismus.

At University Children’s Eye Center (UCEC), we are proud to be one of the few practices offering this specialized treatment for kids and families.

What Is Strabismus?

Strabismus is a condition where the eyes don’t line up properly—sometimes called “crossed eyes” or “wandering eyes.” This can cause double vision, blurry vision, or problems with depth perception. If untreated, strabismus can even lead to permanent vision loss in a child.

Traditionally, strabismus is treated with surgery to adjust the muscles that move the eyes. While surgery is highly effective, Botox injections have become a valuable alternative for certain cases.

How Botox Works in the Eyes

Botox works by temporarily relaxing overactive eye muscles, which allows the eyes to realign. The procedure is:

• Quick – usually under 5 minutes

• Minimally invasive – no cutting or stitches are required

• Done under anesthesia – but with far less time under anesthesia than surgery

• Well tolerated – with little to no discomfort afterward

In many cases, Botox offers the same success rate as surgery, especially for children with acute onset esotropia (a sudden inward turning of the eyes).

Advantages of Botox Over Surgery

Recent studies, including work by Dr. Mark Engel of UCEC, show several benefits of Botox for strabismus:

• Much shorter anesthesia time – only a few minutes compared to over an hour for surgery

• Earlier treatment possible – which can improve a child’s chance of developing normal binocular vision

• Lower risk of permanent overcorrection – a common concern with traditional surgery in certain cases

• Less scarring of eye muscles – making future surgery easier if needed

• Faster, more comfortable recovery – most children feel little to no pain afterward

Who Might Benefit Most?

Botox isn’t the right choice for every child with strabismus, but it can be very effective for:

• Children with sudden-onset (acute) esotropia

• Kids with partially accommodative esotropia (a type not fully corrected with glasses)

• Children with cerebral palsy or other developmental delays, where surgery carries a higher risk of complications

• Cases where surgery has failed or needs to be delayed

That said, Botox may be less effective for children with large-angle eye misalignments or long-standing strabismus. In these cases, surgery may still be the best path forward.

What Families Should Know

Like any treatment, Botox has potential downsides. The effects are temporary, and some children may need repeat injections. There can also be short-term side effects such as drooping of the eyelid or temporary outward turning of the eye, but these usually go away within weeks.

Most importantly, Botox for strabismus is safe when performed by experienced pediatric ophthalmologists like those at UCEC.

A Partner in Your Child’s Care

At UCEC, our doctors carefully evaluate each child and work closely with parents to decide whether Botox, surgery, or another treatment is the best option. Our goal is always the same: to preserve vision, improve alignment, and support your child’s overall well-being.

✨ If you’d like to learn more about Botox for strabismus or schedule an appointment, contact our team today.