The purpose of this study was to study the effect of Botulinum Toxin (BT) in refractive and non-refractive accommodative esotropia unresponsive to glasses and poor compliance with glasses. This was a retrospective study of 114 patients who had BT for accommodative esotropia. Twelve were excluded from analysis as they had additional ocular disease. Of 102, 48 were male, 71 were <6 months of age at strabismus onset, 19 had developmental delay or Down’s syndrome and 26 had amblyopia. Average age at BT was 47 months, SD 34.9. Hypermetropia >+2D was present in 32 (refractive cases). The remaining 70 patients were non-refractive with cyclo refraction of <+2D and with high accommodative-convergence over accommodation (AC/A) ratio. Average angle pre injection was 40D and 49.3D for distance and near. At six months post-BT, average angle was 24.5D and 27.66D at distance and near. BT effect was noted by parents at the third to fifth day. Four patients were lost to follow-up at two weeks. Excellent alignment <10PD was achieved by 59 patients, six had small residual angle of 11-20PD, 21 had large residual angles >20PD and 12 were exotropic. Average angle was 11.06PD (exo 10 – eso 70; SD18.52). At six months follow-up, 42 were <10PD, nine with small angle and 41 with large angle esotropia. Average angle was 24.5PD (0-100, SD 23.4). Complications included ptosis (38), exotropia (12) and hypertropia (5) at two weeks post-BT. All resolved by six months. Limitations of this study are its retrospective design, limited binocular assessment and short follow-up period. The authors recommend longer term studies to evaluate outcome-related factors and optimal dose of BT. There were no significant associations found for outcome with age at onset, age at BT, developmental status, amblyopia, refraction and angle of deviation.