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Acute-onset esotropia (ET) is a rare presentation of Chiari I malformation. The ET may resolve following neurosurgical decompression, although this is not usually immediate.1 Where neurosurgery is not undertaken, Kowal et al2 suggest prismatic correction or strabismus surgery. The latter may result in temporary correction of the strabismus, as the strabismus can recur and resolves only following decompression.3 Botulinum toxin (BT) has been reported as successful in one case where the ET did not resolve following neurosurgery.4 Despite BT being a common treatment for acute acquired concomitant ET,5 no previous case has been reported in which BT …
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