• Purpose: To evaluate the long-term results of medial rectus recessions augmented by botulinum toxin injection for treating infants with large-angle (> 60 prism diopters [PD]) infantile esotropia. • Design: Interventional case series. Methods: settings: Hospital-based clinical practice. patient population: Twenty-three patients with large-angle infantile esotropia who were followed for at least 2 years postoperatively. intervention: Surgical treatment with botulinum toxin in addition to bilateral medial rectus muscle recessions. The preoperative findings, treatment, and outcomes were reviewed. main outcome measures: Surgery was considered successful if the patients did not require additional horizontal strabismus surgery and had less than 10 PD of horizontal deviation. • Results: The age at surgery ranged from 4 to 36 months (mean 14.5 months) and the angle of esotropia ranged from 65 to 100 PD (mean 72 PD). Treatment was successful in 17of 23 patients (74%), with follow-up of 2 to 13 years (mean 6.6 years). Conclusion: Botulinum toxinaugmented medial rectus recession is an effective treatment for large-angle infantile esotropia, with stable results over time.