My vision is blurry post Botox, what can be done to rectify this issue? (Photos)

Question

Botox caused this one week one! I had forehead and crows feet done and my vision is blurred. Will Botox in other areas help rectify

Jason Emer, MD · Answer

unfortunately Botox results last up to 3-4 months, and you currently have an eyelid that is weak becuae of the botox.  this happens from frank bad luck.  it can be softened with venus legacy and thermage radiofreuqnecy treatments as well as iopidine eyedrops. I suggest speaking to your physician.    This should subside over time, I recommend getting a formal evaluation with a cosmetic dermatologist to review your options. Best, Dr. Emer.

Dean P. Kane, MD, FACS · Answer

Dear ironlady 1978:

Sorry for your troubles! Thanks for sharing your photos.

Botox relaxes muscles but also works on glands. Proper injection is an art and a science and takes talent, anatomic understanding and skill. Despite these qualities, even the best injector will have a rare complication. Botox diffusion for eyebrow lift can drift onto the:

1.    eyelid muscle causing ptosis or droop,

2.    affect the lacrimal and eyelid glands causing dryness and possible blurriness from this, and

3.    affect the muscles to the iris and lens also causing blurriness.

4.    relax the muscles of eye movement causing double vision

While temporary, some or all of these symptoms can be reversed for short periods of time with a medicated eyedrop called mydfrin, iodipine and / or Naphcon A.

If your injector is unhelpful, it is best to call a Board Certified Ophthalmologist or Oculoplastics specialist for evaluation and direction. I wish you the best!

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs ironlady1978. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. 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 (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.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 carefully follow the simple aftercare instructions described below. This may be a reason for the low incidence of side effects in my practice.If I had a patient who looked like the person in these photographs I would start with apraclonidine, which should help with the drooping right away.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 two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two 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. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific recommendations. Good luck!

Eric Shreder, DO, MS · Answer

You have lid drooping (known as ptosis). Likely you pupils are also not working correctly - mydriasis (some dilation of the pupil). Both will resolve over time. There may be a way to improve the ptosis with drops - topical apraclonidine 0.5% ophthalmic solution. See an opthalmologist.

Christopher R. Macdonald, FRCS(Plast) · Answer

Thanks for the question and photos.
Is your vision blurry in both eyes?If you lift your right eyelid does your vision improve?
It seems the Botox has ended up too low and is affecting the muscle that lifts your eyelid, giving you "ptosis". It may also have got into your eye socket and be affecting the muscles responsible for moving your eye around, this is most likely the cause for blurriness if it doesn't improve on lifting your right eyelid.
Do not have Botox somewhere else to cure this. This will not work.
Unfortunately you may have to wait for the Botox to wear off. This usually starts to improve after about 6 weeks but can take  3 months to normalise. Please go back to your injector as there are also some eye drops that can help with lifting your eyelid. Your injector must also know about this complication so they can learn from it.
I hope things improve quickly for you.
Goodluck!
Dr Christopher Macdonald
CRM Aesthetics

My vision is blurry post Botox, what can be done to rectify this issue? (Photos)

Answers (6)

Answer: Its Going To Take Some Time, but---

Answer: Its Going To Take Some Time, but---

Answer: BOTOX and blurry vision

Answer: BOTOX and blurry vision

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.

My vision is blurry post Botox, what can be done to rectify this issue? (Photos)

Answers (6)

Answer: Its Going To Take Some Time, but---

Answer: Its Going To Take Some Time, but---

Answer: BOTOX and blurry vision

Answer: BOTOX and blurry vision

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.