Fast facts

Botox 


What it is: Cosmetic injection to relax wrinkle-forming facial muscles intended to reduce fine lines and wrinkles. Botox injections typically last up to 4 months.


What it addresses:

- Lines between eyebrows
- Furrows on forehead
- Crow's feet
- Smile lines
- Neck wrinkles
- Bell's Palsy
- Facial Asymmetry
- Excessive sweating


 
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Question

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

I experienced horrible visual disturbances after Botox injections.  I ended up in the emergency room.  The doctor injected near my lower lash line.  Why did this happen?


Asked by: J.Z. from St. Paul, MN.

Answers (4)

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1
May 28, 2008

Botox Can Reduce Tear Production

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.

2
May 21, 2008

Botox can cause visual changes, most of which can be avoided.

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.

3
April 21, 2008

Botox injections may cause visual disturbances for many reasons

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.

4
April 17, 2008

Botox in the Lower Lids Can Cause Vision Changes

I’m sorry to hear about your vision difficulties after Botox. Fortunately, visual changes due to Botox are temporary, and usually resolve in less than 12 weeks. I know this is of little consolation during the time the Botox is causing vision changes. (There is also a possibility that something besides Botox is causing the problem, but this is less likely.) I use Botox at the lower lid margin to relax the muscle which causes wrinkles at this area. I have also found that eyes can appear more “open” when this injection is done properly. When Botox is injected into the lower lids, there is always a possibility of:

  • Double Vision
  • Other Vision Changes
  • Droopy Eyelids
  • Lower Eyelids Drooping Outwards
  • Lower Eyelids Pointing Inwards

I make sure to discuss this with every patient before treating this area, or any area near the eyes with Botox. Injecting small amounts of Botox at the lower lids is important for optimal results.

I usually only inject 1-2 units at each lid margin at a time. Before and after pictures are important. I always want to recheck my patients in 10 days to evaluate their treatment. More Botox can always be injected at that time if necessary.

I always tell patients that the closer to the eye Botox is injected, the higher the risk of eye and vision side effects. Also, side effects are more common in older patients, particularly with lower lid injections.

For Botox treatment, remember to always seek out an experienced Medical Doctor to perform your treatment. It’s impossible to guarantee no side effects will occur, but seeking out treatment from a experienced Doctor who treats patients personally maximizes your chances of a good result.

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