Why did I end up in the emergency room after Botox injections?

Another rare but possible complication after Botox injection to the "crow's feet" is decreased tear production. If Botox is injected near the lacrimal gland (which resides deep to the outer edge of the upper eyelid), this gland which helps to lubricate the surface of the eye may produce less tears. This effect has been shown to last for 6 months when injected directly into the gland. In someone who has dry eyes to begin with, this could cause worsening of the condition and blurry vision. Luckily, these effects should be temporary.

That being said, Botox is very safe and has a longstanding history of high patient satisfaction and a very low complication rate when properly administered.

Without examining you I can't say for sure what the problem was, but there are at least a few possibilities.

If you had double vision a few days after a Botox injection, you may have some Botox that was injected too deeply and too close to the eye, which could allow Botox to affect the muscles that affect eye movement. This will usually result in double vision.

If your eye(s) became dry and painful, you may have received too much Botox near your lower lid, which could cause the lower lid(s) to be unable to close all the way. This could lead to very painful eye dryness.

If you could not see due to sagging upper eye lid(s), then you may have had Botox injected too deeply and too low over the eyebrow, which allowed the Botox to migrate into your upper eyelid(s). This could cause your upper eyelid(s) to droop.

If you got flu-like symptoms after being treated with Botox, then you may be one of the unlucky individuals who gets nausea, chills, sweats, etc. due to a systemic reaction to Botox. Nothing can be done to predict who will get this side effect (unless you have had this side effect in the past!).

The good news is that these side effects will wear off and they can be avoided in the future.

There are numerous reasons that Botox injected in the lower eyelid can cause visual disturbances. Botox acts to prevent muscles from contracting.

• If the muscle around the eye is unable to contract, the tears may not get "pumped" out of the eye and the tears will then pool in front of the pupil distorting vision.

• In addition, the eyelid may not close properly and the front of the eye, the cornea, can dry out and reduce vision or create hazy vision.

• Closer to the eye behind the eyelid is the inferior oblique muscle which controls eye movement. If the Botox were injected in such a way that this muscle was affected, the patient would generally experience double vision.

Other ocular side effects would be extremely rare.