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Eyelid Droop and Frozen Pupil After Botox

Will this wear off or is there the possibility of permanent damage? A blood vessel above my left eye bled quite profusely after the injection and left bruising which is still visible 2 weeks after injection. Is there a connection? Right eye is fine. How does the botox get to the eye to cause the pupil to freeze? All help gratefully accepted as I am very worried

Doctor Answers (7)

Eyelid droop and frozen pupil related to Botox?


Eyelid droop can happen if the Botox was injected in the brow and drifted down into the muscles that cotrol the elevation of the eyelid.  That will eventually wear off if Botox is the cause.

Although theoretically a dilated or frozen pupil is possible due to Botox, I recommend a consultation with a neurologist or ophthalmologist immediately to rule out other, more serious causes. 

Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Eyelid droop and frozen pupil after Botox


Although this may turn out to be related to Botox, it may be that the timing is purely a coincidence and that you have a potentially life-threatening aneurysm in your brain causing a third nerve palsy.  I suggest you go to the emergency room to see a neurologist or ophthalmologist immediately and get evaluated.

Yoash R. Enzer, MD

Yoash R. Enzer, MD, FACS
Providence Oculoplastic Surgeon
4.0 out of 5 stars 5 reviews

Issues with Botox Injections


  Botox relaxes muscles leading to the relaxation of lines and wrinkles and yes, if the Botox is placed to close to the eyebrows, the eyebrows and or the upper eyelids can droop.  This will eventually go away (several months) any you can avoid having Botox placed in that area in the future.  Raising and lifting the eyebrows and closing the eyes can increase muscle activity and may make the Botox wear off sooner...but the effects are not permanent.

There should be no effect, on the pupil itself and if your pupil seems truly different tahn beofre the Botox injection, you should see an Oplthalmologist for an eye exam ASAP.  I should tell you that I have never heard of this before.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

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Pupil involvement from Botox


There have been reports of reversible pupil dilation after Botulinum toxin injection around the eye area, so it should go away. However, you should still consult an ophthalmologist or neurologist to rule out any other causes.

Dr Taban

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 12 reviews

BOTOX has been reported to affect the cillary ganglion which can affect the pupil.


Dear Eileen

This is alarming and warrants evaluation by an ophthalmologist and possibly a neuro-ophthalmologist.  I am not aware of a published report of a cosmetic BOTOX treatment affecting the cillary ganglion but this is certainly possible.  It is likely that the treatment effects will wear off as the BOTOX wears off.  However, because this is so unusual, it is highly recommended that you get an immediate evaluation by an opthalmologist, and possibly an assessment by a neuro-ophthalmolgist.  They will be able to investigate the situation and provide support and reassurance based on actual examination.  Iopidine  drops might possibly help your eyelid position and are worth trying.  One theory about deep orbital complications seen following BOTOX of the eyebrow is that the medication can track through blood vessels into the orbit causing deeper complications.  Obviously a bruise at the time of your treatment might be consistent with such a mechanism.  Please get immediate medical attention for this situation. 

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

This does not sound like a treatment-related problem


The symptoms you are complaining of, in particular the changes to your pupil, do not sound at all like they are related to treatment with BOTOX®.

There are various neurological conditions which might produce this symptom complex, but you would need to see an ophthalmologist or neurologist to sort that out.

I very much doubt that the buising you had is related to the other things you are describing.

You should at least return to the doctor who treated you with BOTOX® so that you can be properly assessed, advised and if necessary referred.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon
4.0 out of 5 stars 2 reviews

Eyelid droop can happen rarely after botox but not frozen pupil


An eyelid droop can happen if the levator muscle of the upper eyelid gets affected but this is a temporary effect.  A frozen pupil, however, should not happen even rarely, so you should get this evaluated immediately.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.