Eyelid Ptosis following Botulinum a Exotoxin Injections Reversed with Apraclonidine

Abstract

Introduction:

While use of botulinum A toxin (Botox Allergan, Inc, Irvine, Calif) injections for cosmetic use is generally considered safe and efficacious, uncommon side effects can occur. We present the case of a 52-year-old woman that experienced eyelid ptosis following botulinum toxin injections in the glabellar and forehead regions.

Materials and Methods:

The patient received botulinum toxin injections in a standard fashion to the glabellar, forehead, and lateral canthal regions. A total of 32 units (0.8 mL of botulinum A toxin diluted to 40 units/mL) was used.

Results:

Five days following botulinum toxin injections, the patient experienced unilateral eyelid ptosis, which was successfully treated with apraclonidine 0.5% eyedrops (Iopidine, Alcon Labs, Ft Worth, Tex) to the affected side. Resolution of the ptosis occurred within 1 week of initiating treatment.

Conclusion:

Although eyelid ptosis can be an undesirable sequela of botulinum toxin injections for cosmetic purposes, measures can be undertaken to avoid this adverse effect. Fortunately, unintended effects from botulinum toxin are temporary. Ptosis can be ameliorated with apraclonidine eyedrops.