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A total of 27 children with esotropia (mean age, 3.9 years; range, 9 months to 13.8 years) were enrolled in a 9-month observational study following botulinum toxin A (BTX-A) injection of one (n = 7) or both (n = 20) medial rectus muscles. BTX-A dosage ranged from 3.0 to 6.0 units per muscle. Three participants developed tonic pupil, noted at the first follow-up visit, occurring 12-19 days after injection. All 3 cases occurred in the left eye of participants who underwent bilateral BTX-A injection by the same surgeon. Anisocoria diminished from a maximum of 4 mm at the 2-week visit to 1–2 mm in all patients over the 9-month postinjection data collection period. No adverse visual outcomes were noted. Tonic pupil is an infrequently reported complication of BTX-A injection for strabismus. The experience of our investigator group suggests the need for careful injection technique and thorough preinjection counseling.

To evaluate postoperative refractive changes in aphakic and pseudophakic children in a comparative case series.The medical records of pediatric patients with aphakia and pseudophakia were reviewed retrospectively. The mean change in refractive error from one postoperative examination to the next was calculated at each age to give aggregate curves of postoperative refractive change for each group.A total of 233 aphakic and 92 pseudophakic eyes were studied. The median age at the time of surgery was 0.8 years (range, 0.0-16 years) for patients with aphakia and 7.3 years (range, 1.5-19.9 years) for patients with pseudophakia (P.0001). The postoperative refraction curves at comparable ages of 2 to 20 years showed a total mean myopic shift of 1.5 D for patients with pseudophakia and 7.8 D for patients with aphakia. An age-matched subset of patients with aphakia also showed more myopic shift than those with pseudophakia.Pseudophakic eyes show less postoperative myopic shift than aphakic eyes. Selecting intraocular lens powers aimed at producing initial emmetropic refractions has been a good strategy in our cohort of patients with pseudophakia. However, our data are insufficient for conclusions regarding children with pseudophakia younger than 2 years, in whom larger myopic shifts may occur.

Orbital cellulitis is a rare complication of strabismus surgery. We report a case of a 4-year-old boy with bilateral orbital cellulitis after uneventful surgery to correct esotropia. Concomitant sinusitis was the likely source of infection. To our knowledge, this is the first case of bilateral orbital cellulitis following strabismus surgery.