Recently, a 3-year-old girl, Kiki (a pseudonym), went to the Department of Ophthalmology of Children’s Hospital of Fudan University due to a sudden onset of esotropia. After a thorough evaluation, experts tailored a personalised treatment plan for her, using micro-injection technology with no incision and micro-trauma, and completed the injection in both eyes in less than 5 minutes. The next day, the child's internal oblique degree dropped by 80%, and the symptoms basically disappeared. Kiki became the youngest child in Shanghai to have her acute common esotropia treated with botulinum toxin injections.
Kiki's parents found that her eyes suddenly developed an inward slant that resembled ‘cock-eye’ after she used tablet computers and other electronic products for a long period of time, and she immediately came to the ophthalmology department of Children’s Hospital of Fudan University for medical treatment. Doctors confirmed that Kiki had acute common internal strabismus, which is a type of strabismus with rapid onset and complex etiology, and prolonged internal strabismus is likely to cause amblyopia and permanent damage to the child's stereoscopic function. Attending physician Cai Xiaojing revealed that the vast majority of children recently seen with this type of disease are associated with excessive eye use at close range. Prolonged exposure to mobile phones, tablets and other electronic products may lead to disorders of binocular fusion, triggering acute strabismus.
Kiki's parents were concerned about the risk of complications associated with traditional strabismus surgery. After careful evaluation, Yang Chenhao, Director of Ophthalmology, offered a new treatment plan that satisfied the parents - Botulinum toxin A injection therapy for Kiki, which injects a precisely adjusted dose of the drug into the overly constricted extraocular muscles, causing the muscle tension to decrease significantly within 1-2 weeks, thus returning the eyes to their proper position.
Botulinum toxin type A is a neurotoxin that temporarily relaxes the overly tense muscles, thereby adjusting the balance of tension in the extraocular muscles and correcting strabismus. Yang Chenhao explained to the parents that Botulinum toxin injection can be done by local injection without opening the bulbar conjunctiva, avoiding the problems of intraoperative bleeding and postoperative scars, and reducing the incidence of serious complications of traditional strabismus surgery, such as muscle slippage and scleral perforation, which is especially suitable for children with special strabismus, such as acute co-morbid internal squint and cyclic strabismus with a shorter course of the disease, as well as for children with a younger age.
After fully communicating with the parents and reaching a consensus, on 24 March 2025, Director Yang Chenhao injected a very small amount of botulinum toxin A into the posterior rectus medialis muscle belly of Kiki's eye through microinjection technique to relax her tight eye muscles, and the whole process of injecting both eyes was completed in less than 5 minutes.
‘The child woke up in the morning after the operation and his strabismus had magically disappeared. I didn't think that injections could cure strabismus!’ To the parents' excitement, the next day after the operation, Kiki's strabismus was reduced by 80%, from 30 prism degrees to 6 prism degrees, and the symptoms of internal strabismus basically disappeared. After the attending doctor's checkup in the morning confirmed that Kiki's strabismus had improved, she was successfully discharged from the hospital on the same day, and she only needed to use eye drops to help her recover during her stay at home.
The Department of Ophthalmology of Children’s Hospital of Fudan University will open a ‘green channel for the diagnosis and treatment of acute esotropia’, integrating visual function training, VR stereoscopic reconstruction and other technologies, to provide a full process of personalised treatment solutions for children. Experts also call on parents to pay attention to children's eye health management, do not let mobile phones, tablets become the child's ‘electronic nanny’, at the same time need to pay attention to the child whether frequent blinking, squinting or abnormal head position, once found should be as early as possible to seek medical attention, strabismus not only affects the appearance, but also may lead to amblyopia and stereoscopic vision loss, early detection and intervention is the key to protect visual function. Early detection and intervention is the key to protecting visual function.