Botox Gave Me a Lazy Eye

Question

I recently moved to New York, and have had Botox previously with   great results.  But on my first visit to a new doctor, I got “lazy  eye.”  Did the doctor do something wrong?  I told him where I had  been injected before.

Sanusi Umar, MD · Answer

The injection may have been placed on one side of the forehead causing the muscle to become excessively relaxed. This is a relatively minor effect that should go away after a few weeks.

	 

	It may have also been injected near the midpoint of the eyebrow. This is the muscle that keeps the eyelid in an elevated state. In this case, the effect can last several months.

Mark K. Markarian, MD, MSPH, FACS · Answer

"Lazy eye" aka Eye-LID droop is a rare but known complication of Botox injection.The good news is that this is NOT a permanent complication and should get better.A droopy eye-LID may occur if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris.  In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop. Typically, a lower dose diffuses onto the levator muscle and so the other good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month.   However, if the eyelid droop occurs shortly after injection (i.e. within 3-4 days), then your eyelid levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months...Apraclonidine (Iopidine) eye-drops for Botox-induced eye-LID droop can provide a small (2mm) improvement -- Apraclonidine 0.5, 1-2 drops, 3 times per day. Make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out. Be sure your prescribing physician discusses all the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...In the future, be sure to seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.Good luck.Dr Markarian

Harold J. Kaplan, MD · Answer

Ptosis, or a mild drooping of the eyelid is the main side effect of Botox. What is most interesting about your description is that you mentioned that you "told him where you had been injected before". Normally, it works the other way around with the practitioner asking you to animate (move) your facial muscles and then determining where to inject for optimal results. Any experienced injector will not need any help in determining the proper location for injection.
With that said, if you are going to get a droopy eyelid from a Botox injection, there is probably a better chance of that happening on your first visit than subsequent ones. Without any prior history, your physician or injector may need to make adjustments to get it right the next time.
The droopy eyelid should resolve soon, the question is whether or not you should give this injector the benefit of the doubt and go back again. If you want to go back in the future, you should go to show him the results now so that he can see the problem firsthand before the effects wear off.

Michael A. Persky, MD · Answer

Botox injected too close to the brow can get into the upper eyelid muscle (orbicularis) and cause the upper lid to droop.  Visine eye drops can sometimes help with the droopy lid for a few hours at a time.
If your actual eye muscle got lazy then the injection was way off.
After treatment it is important to keep your head elevated for at least three hours (definitely avoid hanging from anti-gravity boots).

Narin (Joe) Apisarnthanarax, MD · Answer

One nasty side effects of Botox Cosmetic (probably close to the only nasty side effect) is the droopy eye.  And while this is the rarest of all Botox side effects, it is also the most commonly reported!  So it is happening and people need to understand what has happened.
	
		First know, this side effect will disappear on its own, although it may take 3-4 weeks.  It will not normally last as long as the Botox.  Your injecting physician should have a chance to see you, and possible prescribe some drops that may prove to be helpful.  Or you can invest in a pair of large, dark sunglasses, to help these next weeks pass. 
	
		The reason for this Ptosis (lazy-eye) result is either 1 or 2 things: an inappropriate amount of Botox was injected into the target area, or the injection was targeted for an area too close to another, non-intended muscle group.  Either of these reasons could make the Botox migrate to the set of muscles controlling the upper eyelid  (causing a droopy eye) or the muscles controlling the eye itself (causing lazy eye). 
	
		The best way to avoid these side effects is to always use the finest, board certified physician (dermatologist or cosmetic surgeon), making sure he has extensive experience with facial fillers, and working with Botox Cosmetic around the eye.  A skilled provider should generally provide the safest procedure possible, and less chance for side effects to occur.

Dina D. Strachan, MD · Answer

Eyelid droop, or ptosis, is a known potential side effect of Botox treatments in the forehead. It can usually be avoided by injecting at least 1 cm above the brow. As with the desired affects of Botox, this side effect, too, will resolve over approximatley 3 months. Call your doctor and ask about eye drops to speed up recovery.

Steven Wallach, MD · Answer

Soemtimes when Botox is injected close to the upper eyelid, it can cause ptosis or sagging of the lidr. This will get better on its own over a few months. Eye drops to counteract the effect of the botox can also be prescribed.

Patricia Farris, MD · Answer

What you are describing is the most common complication with Botox. There are things the doctor can do to minimize the risk of ptosis, but for those of us who do a lot of injecting, we do see this on occasion. Good news is it happens rarely and it resolved in 3-4 weeks. I would call their office and they will prescribe some prescription eye drops. These help a lot and can make the ptosis a lot less noticeable.

Peter A. Aldea, MD · Answer

Whenever Botox reaches the upper lid lifting (Levator) muscle, either because it was placed too close to it (injector error) or because the patient rubbed it there, the muscle will be weakened resulting in ptosis (droopy, lazy etc) eyelid. This condition can be improved with eye drops.
You should NOT need to show a Botox expert where to inject Botox. He/she should know where to place it based on your examination, your wishes and your anatomy.

Mark L. Jewell, MD · Answer

What you describe as a &ldquo;lazy eye&rdquo; is technically called ptosis. Although complications from injections of Botox Cosmetic&reg; are rare, ptosis is the most common complication reported.  It results from a combination of the injected dosage and your own anatomy&rsquo;s response to treatment.
Ptosis is benign, meaning it does not affect your health or present any danger to you.  Your appearance will improve over time as the effects of the injection begin to diminish, within 90 days.

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