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The use of sophisticated imaging techniques has led to a greater understanding of the mechanisms of some forms of strabismus. In particular, studies of strabismus in high myopia have demonstrated abnormal muscle courses and provided a basis for corrective surgery. Although injection of botulinum toxin has a place in modern strabismus management, there have been few controlled studies validating its use. An important paper in the review period directly compares botulinum with surgery to confirm its effectiveness for at least one indication.