Xiao Xu, 23 years old, graduated from university and just joined a foreign company, so he has a bright future, but he is under a lot of pressure at work. Recently, he always felt uncomfortable in his neck, and his neck would involuntarily tilt to one side. After being referred to our neurology dystonia clinic, he was diagnosed with spastic squint, and his symptoms were significantly relieved after being given botulinum toxin treatment, so Xiao Xu regained his confidence and returned to his job with hope. In fact, in clinical practice, there are many patients with spastic strabismus who are misdiagnosed as cervical spondylosis and delayed in treatment, which is a great pity, so we need to recognize spastic strabismus. Spastic squint is a common clinical disease of focal dystonia, which is caused by abnormal posture and involuntary twisting and turning of the head and neck due to spastic or tonic contraction of the neck muscles that cannot be controlled at will, and although it is not life-threatening, it can cause different degrees of disability to the patients and seriously affect their work, life and social life, bringing great physical and mental pain. The cause of spastic squint can occur at any age, but it is more common in middle-aged and elderly women, with an incidence of 9 per 100,000. The disease starts slowly, and in the early stage it can be manifested as periodic head twisting to one side, tilting or leaning forward or backward, and in the later stage the head is often fixed in a certain abnormal posture, and the affected muscles often have pain and stiffness, and localized muscle hypertrophy can be seen, which can be aggravated by emotional excitement, mental tension, and work fatigue, etc. It can be reduced when the head is supported and disappears during sleep, so many patients are easily misdiagnosed as psychiatric diseases. Clinically, it can be divided into four types according to the scope of muscle involvement: 1. Rotation type: the head rotates spasmodically or clonically to one side around the longitudinal axis of the body. 2. Posterior tilt type: the head is tilted backward towards the back, facing the sky; 3. Forward flexion type: the head is flexed forward with the jaw against the chest; 4. Lateral tilt type: the head deviates from the longitudinal axis to the left or right, with the ear near the shoulder, often accompanied by ipsilateral shrugging of the shoulder. The drug treatment of spastic squint is mainly dopamine analogues, dopamine receptor agonists, dopamine receptor blockers, short-term dopamine excluders, anticholinergic agents, GABAergic drugs, but the overall efficacy is poor; more serious cases can be treated by deep brain electrode implantation, and some patients can completely control spasticity, but the surgery is expensive. Botulinum toxin injections can paralyze the spastic muscles, which can effectively control the symptoms. We believe that through long-term regular botulinum toxin treatment, the symptoms of patients with spastic squint can be well controlled, thus improving their quality of life and allowing them to return to normal work and life as soon as possible.