Abstract : Introduction : This study aims to analyze the indications, effectiveness and side effects of Botulinum toxin in the management of Childhood Esotropia. Methods : A retrospective study of cases underwent botulinum toxin injection for Esotropia strabismus in King Fahad Armed Force Hospital (KFAFH), Jeddah, Saudi Arabia. From the period 1st of Jan 2014 till 31st Dec 2018. For total of 116 patient. Success was defined as a residual angle of deviation of 10 prism diopter (PD) or less which allows for binocularity for at least 6 months. Result : A total of 81 cases were included. 45 males and 36 females. The mean age at 1st injection was 7.29 with range of 0.58 to 24 year old. The most prevalent diagnosis was partially accommodative esotropia (PAET). the overall success rate was 38.3%(31) with NAET and paralytic ET has the highest success with 76.9%(10) and 100%(2) respectively. Conclusion : Botulinum toxin represents a safe, repeatable alternative to surgery in the management of esotropia type of strabismus. Success rate differs in different diagnoses with NAET scoring the highest.