Severe drooping eye lids after getting botox for Migraines.

Question

I have been getting botox for Migraines for about 2 years, in the last 6 month's I've noticed severe drooping eye lids, my provider is a P.A. when I bought this up to her she was VERY dismissive and said she had never heard of botox causing drooping eye lids, and refused to give me the eye drops. My last injections of botox my eye lid droop became even worse especially in my right eye. I bought some Naphcon A, do you think this will help until I can see my neurologist in June? This is the end of March.

Jason Emer, MD · Answer

Drooping eyelids can be improved with a combination of iopidine drops, venus legacy, and thermage treatments. Botox results will resolve in 3-4 months. Best, Dr. Emer

Thomas J. Lee, MD · Answer

Thank you for your question.  There are a couple of reasons why you can get droopy eyelids (ptosis) after Botox injection to the forehead and the space between your eyebrows (glabella) in the area above your eyes.  
The first way this can happen is if the Botox trickles down your forehead in the tissue planes underneath your skin to the main muscle that lifts up your upper eyelid.  This can last for 3-6 until the botox effect wears off.  In this case, a medication eye drop (apraclonidine) can be prescribed to stimulate one of the secondary muscles to the upper eyelid to counteract the eyelid droop.
The second way this can happen is if you already had brow drooping before you had the botox is administered.  When patients have significant brow drooping, they unknowingly use the frontalis muscle that lifts the eyebrows to compensate.  When the frontalis muscle is paralyzed by the botox, the droopy eyelids/brow become evident.   Your normal function will be restored once the botox wears off, but the droopy brow will still be there afterwards.  We can fix this with surgery.

Leslie Pickens, MD · Answer

Botox and all the drugs in the class of neuromodulators including Xeomin and Dysport for migraines and cosmetic use can absolutely cause droopy eyelids.  If there was what we refer to as eyelid hooding present prior it could be made worse.  It could be your brow that is droopy from relaxing the forehead muscles or your eyelid itself when the injection is made too close to the muscle that raises the lids.  Your naphcon A may help so it is worth a try since it is inexpensive and pretty harmless.  Your injector should be aware of this complication so perhaps you should show her again what you mean or get a second opinion. Good luck.

New You Medical Spa - Chandler · Answer

I am very sorry to hear that you are experiencing this. Unfortunately, without pictures I am unable to assess what is actually going on, whether you are experiencing forehead ptosis or eyelid ptosis.  If it is forehead ptosis (this has been known to happen with migraine treatments), the Naphcon-A won't be of any use.  If it is indeed forehead ptosis, there is the possibility of injecting the opposing muscles to help lift and open your eyes a little bit.  But you will need to go to an injector with aesthetic experience, which is quite different than one who is experienced in neurology.  My recommendation would be to go back to your PA and show her before and after pictures so that she can see exactly what your concern is.  If she continues to be dismissive, or if you do not trust that she has experience in aesthetics, I would seek out an experienced aesthetic injector in your area.  I wish you luck.

Severe drooping eye lids after getting botox for Migraines.

Answers (4)