Botox Caused Eyelid to Almost Close?

Question

After Botox, my lid is almost closed. My doctor must have hit a nerve. How long will it take to look normal again? What should I do?

David Shafer, MD, FACS · Answer

This is a very rare but real side effect of Botox. It happens most commonly if someone injects in the wrong place or uses larger dilution volumes for Botox. It also happens some times for no identifiable reason at all. In any case, it will get better as the Botox wears off over three to six months. It is not permanent. Your doctor can prescribe some eye drops for you that help stimulate the eyelid to open. However, the drops only help lift the lid 1 to 3 mm. Good luck.

Daniel Reichner, MD, FACS · Answer

Tony,
Too much Botox in the wrong places will cause a drooping eyelid. Botox paralysis of the frontalis and/or the levator palpebrae muscles may cause your eyelid to partially close. 
The 0.5% apraclonidine drops can partially help (~2 mm elevation) by contracting the Mueller muscle inside the eyelid. Unfortunately, it takes more than 4 weeks for the significant improvements you are looking for. I recommend that you return to your plastic surgeon to discuss the options for improving your drooping eyelid.

Frank P. Fechner, MD · Answer

The levator muscle action is necessary to keep the lids open. This muscle has been relaxed by the Botox injection, leading to a condition of ptosis. This adverse effect may be shorter lived than the routine Botox longevity of 3-4 months. At its worst, the ptosis may last for the whole 4 months. 
I would recommend that you see your doctor in follow up.

Harold J. Kaplan, MD · Answer

Hi Tony33,
It sounds like you have a condition called "Ptosis" which is eyebrow droop. It occurs when Botox is not injected properly or migrates to a location not intended (the muscle that controls the eyelid). 
Unfortunately, there is no easy fix for the condition.  Your physician will be able to give you a prescription for eye drops, which may help a bit, but you will also need to wait it out as the condition will probably take 2-4 months to resolve completely.  Visit your practitioner for a discussion and follow up.  Good luck.

Steven Wallach, MD · Answer

Closing of the upper eyelid may be one of two things. It could be that the brow is now too heavy to keep elevated and so the eyebrow descends and the upper eyelid is hard to keep open. But, you should be able to open your eye fully. 
The other thing it could be is that the Botox got into the muscle of the upper eyelid and paralyzed it. If this is the case, then you need special eye drops to counter the effects of the Botox until the Botox wears off.

Edward S. Lee, MD · Answer

The most likely explanation is that the Botox drifted lower than where it was initially placed.  The Botox then paralyzed the levator muscle which raises your eyelid.  Without this muscle your eyelid can't open fully and looks like it's halfway shut no matter what you do.
Alphagan are eye drops that can help with this problem.  There is a second smaller muscle that can help to lift your eyelid - Muller's Muscle.  This is stimulated by Alphagan.  So, the eyedrops will get your Muller's muscle to contract and make the eyelid go up a little bit more.  It's often not enough to make the paralyzed side look exactly like the unaffected side.  But it helps.
The eyedrops may also cause irritation; so if you notice any discharge, pain, or redness to your eye, stop the drops for a few days until the symptoms clear.  Paralysis of the levator goes away over time.  It can take anywhere from 3-4 weeks to 2 months.   Good luck and try to be patient.  It will get better.

Bryan K. Chen, MD · Answer

I would return to the individual who injected your Botox for further evaluation. Drooping of the eyelid is an uncommon occurrence and near-closure of the eyelid after Botox is even more unusual. If the injected Botox has migrated to the muscle that elevates the eyelid, you may benefit from Lopidine eye drops.

Scott E. Kasden, MD, FACS · Answer

It will probably take a couple of weeks for the lid to start to lift up, and for you to see again.  It will take longer for the brow and lid to "look normal". Botox can last 4 to 6 months.

George J. Beraka, MD (retired) · Answer

Hi!  It's not a question of hitting a nerve.  What probably happened is the Botox was injected too low in the eyebrow (close to the upper eyelid).
Alphagan eye drops help with this problem.  The good news is it always goes away, but it may take as long as 6 to 10 weeks.

Botox Caused Eyelid to Almost Close?

Answers (9)

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