Right Eye Closed After Botox

Question

I had Botox on the 3rd of April 2009. On the 3rd day after Botox, my right eyelid drooped completely,and now, my eye is in a sleeping position. I can't see anything using that eye because it is fully closed. My doctor is not available for me. Will it ever open again? When? What can I do about this?

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

Unfortunately, you are experiencing a rare but known complication after Botox -- eyelid droop.  This happens when some of the Botox inadvertently diffuses to the muscle that normally elevates the eyelid.  Since the complete effect of Botox is not seen for 7-10 days, in your case the eyelid droop may get a little worse before it gets better -- but rest assured, it WILL get better.The issue now is how long it will take and what you can do about it.  You need to see an experienced physician injector who can examine you.  You are likely a candidate for Apraclonidine eye-drops that may raise your eyelid approximately 2mm.  But note that in some patients, you may not have any improvement at all and will have to wait for the effects of the Botox to wear off for the eyelid droop to improve.  Since the complete dose of Botox is unlikely to have infiltrated onto your eyelid, the lid droop will likely improve in the next 1-2 months (and not the 3-4 months that Botox normally lasts). Rarely, if more Botox penetrated into the eyelid muscle, the lid droop may last longer... But again, the good news is that it IS reversible and NOT permanent.I would encourage you to seek the services of an experienced physician injector.  I think the key 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.

David Shafer, MD, FACS · Answer

A drooping eyelid after Botox is usually due to the unusual effect of Botox migrating into the muscles of the lid, preventing it from opening.  When this happens, you may have to wait for the Botox to wear off before you see resolution of the problem.  The good this is that Botox always goes away and you will be back to baseline within 3 to 6 months.  In the meantime, there are drops that your doctor can prescribe that may help elevate the lid a few mm, but will not lift the lid completely.  Good luck.

Don Mehrabi, MD · Answer

Thank you for your question.
It is very unfortunate that you are experiencing eyelid ptosis (drooping) due to your Botox injection. The main cause for this is incorrect placement of the Botox injection, if it is truly due to the injection itself. Botox wears off in about 3-4 months, but this would be unacceptable for you in the state you are describing. 
However, there is an option for you. You can try Iopidine (apraclonidine) eye drops, one to two drops three times daily, to help open up the eye by raising the eyelid. It is important that you don't have a history of low intraocular pressure, hypersensitivity to this class of medication, or that you aren't taking other glaucoma eye drops. In any case, this would require you to visit your dermatologist, or another dermatologist, to make an assessment and see if this is the right choice for you. It will work, but may not raise your eyelid completely - however, I think you will be pleased with any improvement at this point.
Hope this helps!

Right Eye Closed After Botox

Answers (3)

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.

Right Eye Closed After Botox

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.