Fig. 10 A. Child with a large exotropia. B. Two weeks after botulinum A injection into the left lateral rectus muscle the patient developed complete ptosis. C. Six weeks after injection the patient developed a head position and appeared binocular. Note mild ptosis of the left upper lid and chin-elevated head position. D. Six months after botulinum A toxin injection the ptosis cleared, the exotropia resolved, and the patient remained binocular.