Botulinum toxin (BOTOX®) has been reported to have success as an alternative to traditional surgery for patients with infantile and early onset acquired strabismus. Selected cases with smaller angles may do well with botulinum toxin as a primary treatment; however, the large angle associated with most cases of infantile esotropia in my experience prevents its use. We report the use of botulinum toxin injection into the medial rectus of patients who have already undergone standard incisional medial rectus recessions for esotropia but still have a residual deviation.