The authors report the use of botulinum toxin (BT) as a treatment option in 140 patients with strabismus relating to retinal detachment surgery. The BT dose was 2.5 units of Dysport. Mean follow-up was 27 months (3-203) with a mean age of 47.8 (14-82 years). Fourteen patients had asymptomatic strabismus prior to the retinal detachment surgery. The main presenting symptom was diplopia in 61% and appearance of strabismus in 39%. Post BT, 24% were symptom free, 5% continued with prisms, 18.6% required further BT, 18.5% required surgery, 9% opted for occlusion, 6% refused further treatment and 18.6% failed to attend further appointments. Four patients developed ptosis or vertical deviation following BT. The authors conclude that BT is a safe and acceptable alternative.