I have a lazy eye after Botox. How can I treat this?

Question

Hello I notice I have a lazy eye after Botox injection although didn't happen right away. I notice it when I took a selfie. It hasn't gone away it's been about 3 months. I went to my M.D and she's calling it Monofixation. Have any cosmetic surgeons encounter patients having an lazy eye due to Botox. I also had a facelift. Please let me know. Thank you Kindly

Kally Papantoniou, MD, FAAD · Answer

When Botox affects muscles around the eye, you can sometimes see temporary changes like eyelid heaviness or mild asymmetry. A true “lazy eye” or monofixation isn’t a typical side effect of Botox, and seeing it months later makes it less likely to be caused by the injections alone.

Since it’s been a few months and the issue hasn’t improved, it may be helpful to have an evaluation with an ophthalmologist. They can give you a clearer idea of what’s going on and what options might help.

Paul Flashner, MD · Answer

Hi! Eyelid or eye asymmetry can occasionally happen after Botox if the product affects nearby muscles. Since it’s been a few months, it’s best to have it evaluated in person. We recommend calling your closest SkinMD location to schedule a complimentary consultation with one of our experienced injectors. They can assess what’s going on and advise you on the best next steps.

Danielle Shanley, MD · Answer

Thank you for your question and for sharing your experience.

It is possible to develop temporary eye issues after Botox, particularly if the product diffuses near muscles around the eye that control movement. In rare cases, this can lead to symptoms like a "lazy eye" or what your doctor referred to as monofixation. Given that you also had a facelift, it's important to consider how healing tissues and muscle function might interact.

Typically, Botox-related side effects improve as the product wears off over 3–6 months. Since it has already been about three months for you, some improvement might still occur naturally, but I recommend a thorough evaluation by an oculoplastic surgeon or a neuro-ophthalmologist. They specialize in eye muscle function and can offer options such as temporary prism glasses, eye exercises, or other treatments depending on the severity.

Falguni Patel, MD, FACOG · Answer

When Botox causes noticeable changes around the eyes such as lid heaviness, it is typically a temporary side effect which can be cause by the placement or amount injected of the neurotoxin. True monofixation is not a common side effect of Botox injections. It may be best to follow up with your primary physician or optomologist to make sure these symptoms are not stemming from another medical and neurological issue.

Erin Smith, MD · Answer

Thank you for the question. It would be most helpful to review photographs of what you are describing or to examine you in person. What you are describing sounds like ptosis which can occur after Botox if it spreads beyond the intended injection site and temporarily paralyzes the levator palpebrae superioris muscle. I would recommend speaking with the provider who performed the Botox injection. They may recommend a trial of alpha adrenergic eye drops.

Mahmood Siddique, DO · Answer

It sounds like you're experiencing a form of eyelid drooping or ptosis following your Botox injection, which can occasionally occur when the Botox diffuses or migrates to nearby muscles responsible for eyelid elevation.
In most cases, this type of effect is temporary and generally resolves within 3-4 months as the Botox gradually wears off. However, since you’ve already noticed this issue for around three months, I recommend a few options that may help improve your symptoms:
Eye Drops: Certain eye drops, like apraclonidine, can sometimes help temporarily lift the eyelid by stimulating nearby muscles. Your doctor may prescribe these if appropriate.
Consultation with an Ophthalmologist: Since you’re experiencing prolonged symptoms, it might be helpful to see an ophthalmologist, especially one who specializes in cosmetic or oculoplastic surgery. They can assess any underlying muscle function issues and may offer solutions tailored to your case.
Patience with Recovery: Botox effects gradually fade, so it’s likely that your symptoms will continue to improve as the treatment wears off. However, be sure to keep your provider updated on any changes.
It’s encouraging that your doctor has been monitoring your case, so keep following up with them.
Best wishes for a full recovery.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. Usually the droopy eyelid is the result of Botox effecting the muscle which raises the eyelid. I trademarked a drop which can be used to correct this problem “Drop N’ Lift). See an oculoplastic surgeon for proper guidance. 
Good luck!

Jill Hessler, MD · Answer

One can get a 'lazy eye' or dropping after botox for two main reasons. If the forehead is treated it can smooth the forehead lines but also be difficult to raise the eyebrows making them drop. Or there can be true ptosis, and the eyelid margin or lash line, is lower covering more of the colored part of the eye. This can be treated with eye drops prescribed by your doctor. Both of these effects are temporary and should wear off within 3-4 months but often sooner.

E. Victor Ross, MD · Answer

This is the most common complication after Botox, having a temporary lazy eye. 
 Happens in up to 5% of patients but depends on lots of variables as far as age, amount of Botox, and where it is placed. 
 Time will always make it go away, but can take up to 4 to 6 months,
 there are eyedrops such Upzeeq that can help make the condition better while waiting for the Botox to wear off.

Donald B. Yoo, MD, FACS · Answer

A lazy eye or ptosis after administration of Botox may happen when the neurotoxin diffuses into the muscle that raises the eyelid, levator palpebrae superioris, and prevents it from contracting and functioning properly. Apraclonidine drops are helpful in countering the appearance of a lazy eye while the effect of Botox wears off, sometimes taking up to 3-4 months but typically sooner since when Botox is injected correctly then the amount to reach the levator palpebrae superioris is exceedingly small.

The effects of Botox are temporary, so I would not expect any ptosis or lazy appearance of the eye that are a result of Botox to remain permanently.

The effects of Botox are temporary, so I would not expect any ptosis or lazy appearance of the eye that are a result of Botox to remain permanently.

I have a lazy eye after Botox. How can I treat this?

Answers (18)

More Botox Questions

WE SEND PRETTY
EMAILS

Answers (18)

More Botox Questions

Could my crooked smile after Botox be caused by nerve damage? (photo)

Botox injection in pain, is that normal? Was not relaxed!

Under eye wrinkles versus malar bags ? What procedure could I have to reduce these wrinkles? (Photo)

Scrotox, no result?

What can be done to improve my lumpy neck skin? (Photo)

Is it safe to get Botox or fillers if you have autoimmune condition?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS