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More Eye Drops for Droopy Eyelid After Botox?

I recently had Botox injections in forehead, between the brows, crows feet, and above the right brow for symmetry. I now have a horrible droopy eyelid that is extremely upsetting and uncomfortable. I am presently on Brimonidine 0.2% for prevention of Glaucoma, which I thought would take care of my eyelid. It's not working though. Is it safe to add another eye drop? Thank you. Please help.

Doctor Answers (2)

Use Visine (or generic tetrahydrozoline) eye drops for droopy eyelids after Botox


If an alpha agonist eye drop such as brimonidine fails to minimize ptosis (droopy eyelids) after few days, you should use Visine (or generic tetrahydrozoline) eye drops a couple times a day and you should see some improvement as it works to strengthen Mueller's muscles on eyelids. Mueller's muscles are contracted when you are awake to keep your eyelids lifted. Even without intervention, most ptosis from Botox should subside after 4 weeks.

Bay Area Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Brimonidine is an alpha agonist.


Dear Helen

Brimonidine is an alpha agonist and its mechanism of action is analogous to Iopidine, the drop that is customarly used to raise the eyelid after BOTOX causes ptosis. If the brimonidine you are using is not raising the eyelid, it is likely that Iopidine won't either. I recommend that you consult your general ophthalmologist and let him or her supervise you in a one week trial with Iopidine in addition or as an alternative to brimonidine. However, as you don't seem to be responding to brimonidine, don't hold out high hopes that this drop will work either. Eventually the ptosis will wear off, so the most important thing here is to make sure that your glaucoma stays well managed.

I have just submitted for publication a study of this issue of upper eyelid ptosis after BOTOX and the use of alpha adrenergic drops. Here is the bottom line, while many of the cases of upper eyelid ptosis last on the order of weeks and are mild, some are not short lived and can last many months. What we found was that if you respond to the alpha adrenergic drops and the eye opens, then it is likely that the upper eyelid ptosis you are experiencing will resolve in 4 to 6 weeks. However, if you don't initially respond to the drops, then it can take 3 to 6 months for the ptosis to resolve. You are welcome to have your general ophthalmologist contact me if they have specific questions regarding your situation.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 18 reviews

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