130237 Strabismus surgery under local anaesthesia at a tertiary eye hospital: a 5-year case review

decompensating strabismus.This study evaluates its efficacy as a first-line treatment for esotropia, exotropia, and esophoria.This retrospective cohort study included 15 paediatric patients treated at Manchester Royal Eye Hospital between 2019 and 2024.Inclusion criteria were patients under 18 years with primary decompensating strabismus managed initially with BTX.Outcomes assessed included clinical alignment, symptom resolution, need for further intervention, and complications.Statistical analysis used the Mann-Whitney U test.The mean age at treatment was 8.9 years, with a nearequal gender distribution.The most common diagnosis was esotropia (n=8), followed by esophoria (n=4) and exotropia (n=3).The overall success rate was 86.7%, with complete or presumed success highest in esophoria (100%) and esotropia (87.5%).BTX was well-tolerated, with no significant complications.Sixty percent of patients required further intervention.BTX demonstrated favourable outcomes in managing paediatric decompensating strabismus, especially esodeviations.Although long-term success may require additional treatment, its safety and minimally invasive profile make it an effective bridging or primary therapy.Botulinum toxin A is a safe, effective, and repeatable intervention in select paediatric strabismus cases.It may delay or reduce the need for surgery, particularly in esotropia and phoric deviations.Prospective studies are recommended to refine treatment protocols and patient selection.