Historically, the success of surgery for infants with large-angle esotropia was limited by the amount of medial rectus muscle recession that was considered safe. Initially, most surgeons restricted their medial rectus recessions to approximately 5 mm, anticipating an under correction that could be addressed with lateral rectus muscle resections during a second surgery. Over time, the maximal amount considered safe for medial rectus muscle recession has increased, and now most surgeons are comfortable performing 6- to 7-mm recessions in patients with large-angle esotropia.Others have recommended small medial rectus muscle recessions combined with unilateral or bilateral lateral muscle resections, because of the potential risk of overcorrection with large medial rectus muscle recessions. Other studies reported the use of botulinum toxin augmentation of medial rectus muscle recession in patients with large-angle infantile esotropia.