الفهرس 
1-Acknowledgment.
Chapter 1 : Botulinum toxin.Only 14 pages are availabe for public view
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Abstract
In this study we used botulinum toxin A in the treatment of the cases of small angle consecutive and residual esotropia and exotropia. Thirty three patients fulfilled our inclusion criteria, 72.7% females and 27.3% males, the mean age was 7.4 year, the mean pretoxin angle was 21.7.The 48.5% esotropics and 51.5% exotropics. In 51.5% of patients BTXA was accidentally disseminated to the surrounding tissues during the injection and in 48.5% of patients the toxin was trapped inside the muscle sheath. All patients received 2.5U of BTXA injection under general anesthesia in the surgical room at Abou El Reesh pediatric hospital .
During the postoperative follow up, two items were most important, the first was the Ocular alignment which was 81.8% immediately postoperatively (throughout the first week), this improvement decreased gradually over 6 months to reach 36.4%, due to fading of BTXA effect with the time. More than one third of patients had ocular alignment after a single injection of BTXA. The most significant factor affecting success of BTXA in our patients, was the pretoxin angle, where smaller pretoxin angle achieved the best postoperative ocular alignment. The second was The ptosis which was the most prominent postoperative complication, it occurred in 51.5% of patients and resolved within 1 month postoperatively. The most significant factor related to postoperative occurrence of ptosis was the accidental dissemination to the surrounding tissues.
We recommend the use of the Botulinum toxin A in cases of small angle residual or consecutive esotropia and exotropia as an alternative to surgery being more easy and less invasive .