Yes it is okay to use Alphagan drops after Botox

A drooping eyelid after Botox is a known, but very rare, temporary complication of Botox. This complication, however, must also be distinguished from drooping of the eyebrow, which causes a "fullness" in the upper lids - this is much more common than an actual ptosis (drooping) of the eyelid.

For true ptosis of the eyelid, drops do help.

It is okay to use Alphagan drops even if you do not have glaucoma. The only contra-indication to using Alphagan drops is if you are also taking a monoamine oxidase inhibitor. The reason that Alphagan drops and some other glacoma drops are used for droopy eyelids after Botox is that the drops stimulate a muscle in the eyelids which helps elevate them a millimeter or two. The lid elevation was first noted in patients taking the drops for glaucoma, but now the drops are also in common use for temporary relief of droopy lids after Botox.

For the patients that have be referred to me, I recommend Iopidine (Apraclonidine) Eye Drops. These drops work on a tiny muscle in your eyelid and help pull it up 1 to 3 mm. The drops must be repeated a few times a day for a continued effect. If you have drooping eyebrows leading to full eyelids, these eye drops will have no effect. This leads to the usual warning that you should only have Botox injected by an experienced person.

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Botox given around the eye area has a potential to affect the muscle that opens the upper eyelid. This causes a drooping of the eyelid, which can be very concerning to patients. This happens rarely (less than 1% of the time). Experimental evidence has shown that botox can diffuse from an injection site approximately 1 inch or 2.5 cm.

Although the amount that reaches areas next to the treatment site does not often cause problems, there are cases where side effects occur. Frown line injections or injections underneath the tail of the eyebrow (to produce a brow lift effect) are the most likely treatments to cause a droopy eyelid.

With that in mind, remember that this problem is temporary in nature. It will often wear off long before the cosmetic benefit of the injection has. Treatment with eyedrops, such as Alphagan or Iopidine, can help to soften the lid drop, by raising the eyelid 2mm or so. It does this by stimulating a different eyelid muscle that was not affected by botox.

Alternatively, some patients will wear their glasses or purchase a pair of nonprescription glasses to help conceal the droop. Others will just use a cover story of an eyelid infection during the period of recovery.

If the eyelid drop starts 3-4 days after the injection, then it will probably last about 3-4 weeks. If it starts 4-6 days after the injection, then it should wear off faster. Good luck and remember that it will absolutely get better.

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