The authors report updated experience on factors influencing botulinum toxin (BT) outcomes for strabismus following retinal detachment surgery. This was a retrospective review of 32 patients with follow-up of 20 months (1-132). Mean age at BT injection was 44 years (21-79) and 65% were male. Retinal surgery included pars plana vitrectomy in 62% and cryobuckling in 38%. Treatment response was graded as A – good if ≥50% reduction in baseline angle and / or reduction in diplopia or restored heterophoria; or B – poor if <50% reduction in baseline angle. Fifty percent were good or poor responders. The majority of poor responders had vitrectomy procedures (89%). Most had secondary exotropia. Eighteen percent with vertical or combined deviations had encirclement surgery. Repeat BT was needed with a mean of six to eight injections. Fifteen percent had complications including consecutive exotropia, secondary vertical deviation and intractable diplopia. The results show the potential for BT to restore ocular alignment and binocular vision. Poor response was associated with poor baseline vision and multiple retinal surgeries. There is a changing trend in surgery for retinal detachment. BT remains a useful alternative treatment for related strabismus.