How long will my droopy eye last? I had Botox 6 weeks ago. Will my eye return to normal? (Photo)

Question

I'm starting to get very worried . I have been using the iopidine drops twice a day but really only when I go out as I've found they only work for roughly 4 hours! . Will my eyelid return back to normal ? I've got slight moment in my brows but I haven't seen any improvement to my eyelid. On 23rd June 2017 I had Botox and on 4th july noticed a dramatic droopy eyelid . I didn't go back to the person that done my injections I went to another doctor to prescribe me the drops . Information please

Martin Jugenburg, MD · Answer

I'm sorry that you had to experience this adverse effect from your botox treatment.   Botox generally lasts 3-4 months you will need to wait for the botox to wear off then your eye will go back to normal.

Munir Somji, BSc, MBBS · Answer

You are doing the right thing taking iodipine drops. Repeated use can make the eye dry so I recommend buying some lubricating eye drops to use at night. No matter what most clinicians say eyelid ptosis is a side effect of Botox irrespective of technique. There are many other factors in play apart from technique. Aftercare post Botox treatment is paramount. Bruising can increase the risk as well as rubbing of the eyes post treatment. The important thing is that the side effect is temporary. The cases I have seen settle down after 6 weeks but dependent on the severity can last much longer.

Kenneth D. Steinsapir, MD · Answer

Generally I find that when Iopidine works at all, it indicates the upper eyelid ptosis will resolve in 4 to 6 weeks, possibly sooner.  When the Iodine does not initially work, the ptosis will last much longer.

Susan Chapman, MD · Answer

I am so very sorry for your unfortunate experience with Botox.  The good news is it will go back to normal.  Being you are seeing an improvement with the eye drops even if it is temporary is a good indication the problem should resolve sooner than the normal 3 or 4 months for the Botox to dissolve.
Good Luck

Alim R. Devani, MD, FRCPC · Answer

Thanks for your question and sorry to hear about the adverse effect. This occurs in 2% of patients and happens even to the best injectors. The effect lasts usually about 4-8 weeks and can take up to 4 months to fully recover. Try to stay active as it can help to increase your metabolism and speed up recovery of the eyelid ptosis.

Shaun Patel, MD · Answer

Sorry to hear about your experience but hang in there. You are doing the right thing using the drops. The Botox can take 3-4 months to wear off and when it does, the eyelid will return to normal. You just need to give it more time.

Pamela Stuart, MD · Answer

Unfortunately this condition can last for several weeks or months until the Botox has lost its effectiveness. The iodipine drops you have been given may help alleviate some of the droop temporarily. Be sure and speak to your provider so they can assist you and monitor your progress.

Richard E. Moore, MD · Answer

Thank you for your question and posting your pictures. I am sorry to hear you have suffered from this complication. Since you are about 8 days out from your injections, the Botox is reaching the peak of its effectiveness. It is not unusual for the ptosis (drooping of the eyelid) to get worse before it gets better as it can take 10-14 days for the peak effects of the Botox to be reached. Unfortunately, beyond the iodipine, time is the only other thing that will help. Fortunately, it will fully resolve. Usually, the ptosis begins to improve after 2 to 4 weeks but it can take 3-4 months to fully resolve in some individuals. This complication is reported to occur approximately 1% of the time. In the hands of a highly experienced injector it is going to be much less frequent. This condition is caused by the diffusion of the Botox such that the muscle that elevates the eyelid is effected. Once again, I am sorry to hear about your condition. I know it can be very troubling. I would follow up with your injector to make them aware of what has happened. I hope this was helpful - Dr. Moore.

Alex Eshaghian, MD, PhD · Answer

Thank you for
your question and for sharing your photograph ifeelrubbish85. I am sorry to hear about your situation and I understand your
concern. Botox is a purified protein used to address wrinkles associated with
facial expression.The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns, and the crow's feet seen around the eyes when one smiles. The pivotal studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months.With any injection there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within 2 weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take 2 weeks for full resolution.In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Most importantly are muscles required to perform various functions. The muscles that are treated with Botox around the eyes are close to the muscle that lifts the upper eyelid. If this muscle is affected it can lead to a temporary droopy eyelid (blepharoptosis). The duration depends on the placement of the product and the dose used. Usually it resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine) and various other medications. For my patients I recommend 2-3 drops to the affected eye 2-3 times per day. When the blepharoptosis begins to wear off patients notice less of a droop when waking up in the morning after the last dose of apraclonidine has worn off. The incidence of blepharoptosis is reported to be approximately 1% but in my experience I find it to be about 0.1%. This is likely due to the fact that when these studies were initially performed injectors may have not been as aware of this adverse effect nor been taking extra precautions to avoid it.Blepharoptosis occurs when Botox is placed near the eye and it diffuses to the muscle that lifts the upper eyelid (levator palpebrae superioris). This is located inside of the orbital rim above the globe. To avoid this side effect I place the product at least 1 cm from the orbital rim. When placing product between the brows I pinch the area to be treated and lift it so that the product is placed in the muscle and is less likely to diffuse around the bone into the orbital space. Diffusion into this area may also be caused by other preventable things. For this reason I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours after a treatment and avoid lying flat for 4 hours after a treatment. Some physicians say that avoiding such activity is not important and they may be correct. However in the absence of definitive data from published studies I err on the side of caution and recommend avoiding such activities. This may be a reason for the low incidence of side effects in my practice.I am not sure I understand the timing you described. Your treatment was on Friday June 23, 2017 and the question was posted 8 days later on Saturday July 1, 2017, before July 4, 2017. In any event the date this question was posted is approximately one week after the treatment. As discussed above most cases of blepharoptosis resolve in 2 weeks to 4 months after a treatment. Patience is important in such difficult times. I always advise patients to return to their original injector with questions, concerns, or complications as they have the most information in terms of the product used, the dose, the placement, the lot number, etc. All of the injectors I know are happy to help patients with complications.
Please follow
up with your doctor for specific recommendations. Good luck!

Steven Wallach, MD · Answer

It will take about 4 months and sometimes a bit longer for the effects of botox to wear off.  ........

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