Infantile esotropia is defined as the onset of constant convergent squint in children less than 6 months of age. Infantile esotropia is mainly treated surgically using either bilateral medial rectus muscle recessions or unilateral medial rectus muscle recession and lateral rectus muscle resection with the main goal being to align the eyes so that single binocular vision may develop. For infants with very large angles of esotropia (>60 prism diopters (PD)), surgery on 2 muscles alone may not be adequate. Approaches to these patients have included large bilateral medial rectus muscle (MR) recessions, smaller bilateral medial rectus muscle recessions combined with resections of 1 or both lateral rectus muscles (LR) or botulinum toxin augmented bimedial recession. Botulinum toxin augmentation of medial rectus muscle recession was reported in three previous studies. Lueder et al evaluated the long-term outcomes in patients with infantile esotropia. The results were good, with a 74% success rate. Based on historical comparisons, this technique appears equally as effective as 3- or 4-muscle surgery and more effective than large bilateral medial rectus recessions alone. Ideally, a prospective randomized study should be performed to more definitively determine which of these approaches is best.