A Comparison of Alpha-Adrenergics (Anticholinesterases) in the Treatment of Eyelid Ptosis After Botulinum Toxin A Administration to the Glabellar Region: A Case Study

Abstract

In 2013, there were over 9.5 million nonsurgical cosmetic procedures performed; of these, over 3.7 million were botulinum toxin A injections. Treatment of dynamic facial rhytides with botulinum toxin, in particular the glabellar region, is not without complication. One of the complications of botulinum toxin A injection is paralysis of neighboring muscles to the target muscle(s) of the treatment area such as levator muscles yielding upper eyelid ptosis. Treatment of upper eyelid ptosis with phenylephrine 2.5% ophthalmic solution at 1 drop to the affected left eye every 8 hours versus apraclonidine 0.5% ophthalmic solution at 1 drop to the affected eye every 8 hours was evaluated. Both apraclonidine and phenylephrine are alpha-adrenergic agonists, more specifically apraclonidine is an alpha-2 adrenergic agonist and thus stimulates the Müller’s muscle providing temporary relief of the upper eyelid ptosis. To decrease the risk of an adverse event of upper eyelid ptosis, it is important to avoid crossing the midpupillary line and to stay 1 cm above the eyebrow. Our experience in the treatment of upper eyelid ptosis with the combination of apraclonidine 0.5% and phenylephrine 2.5% yielded improvement of the adverse event. These findings are similar to those reported by Sharma and Shocker; however, in the current case study discussed, a lesser percentage ophthalmic solution achieved satisfactory results.