Using Alphagan for Droopy Eye from Botox

Question

Would it be okay to use Alphagan P 0.1% to treat a droopy eye cause by Botox even though I don't suffer from glaucoma and neither require medication for lowering the eye pressure?     I am concerned about the fact that I am using a medication that is primarily used to treat a condition that I do not suffer from.  This is my 3rd week post-Botox and I still have droopy eye.   Thanks again for your kind reply.

Richard W. Westreich, MD · Answer

Botox given around the eye area has a potential to affect the muscle that opens the upper eyelid. This causes a drooping of the eyelid, which can be very concerning to patients. This happens rarely (less than 1% of the time). Experimental evidence has shown that botox can diffuse from an injection site approximately 1 inch or 2.5 cm.
Although the amount that reaches areas next to the treatment site does not often cause problems, there are cases where side effects occur. Frown line injections or injections underneath the tail of the eyebrow (to produce a brow lift effect) are the most likely treatments to cause a droopy eyelid.
With that in mind, remember that this problem is temporary in nature. It will often wear off long before the cosmetic benefit of the injection has. Treatment with eyedrops, such as Alphagan or Iopidine, can help to soften the lid drop, by raising the eyelid 2mm or so. It does this by stimulating a different eyelid muscle that was not affected by botox.
Alternatively, some patients will wear their glasses or purchase a pair of nonprescription glasses to help conceal the droop. Others will just use a cover story of an eyelid infection during the period of recovery.
If the eyelid drop starts 3-4 days after the injection, then it will probably last about 3-4 weeks. If it starts 4-6 days after the injection, then it should wear off faster. Good luck and remember that it will absolutely get better.

Jerome Edelstein, MD · Answer

Eyelid droop can be corrected with a prescription eye drop (Iopidine 0.5%). This can help alleviate the droop within a few weeks to a month. You can also wait a couple of months for the effects of the Botox to wear off, at which point the droopiness will also go away.

Richard J. Bruneteau, MD · Answer

It’s
not unusual for patients with transverse forehead wrinkles and vertical frown
lines to undergo treatment with botox. Unfortunately, the botox can sometimes
migrate and affect the surrounding structures. When botox migrates in an
inferior direction, the elevators of the eyelid can be effected which causes
the eyelid to droop. This occurs in about 1 to 3% of patients undergoing botox
injections and appears to be related to the technical skill of the injector.

When
this situation arises, it usually takes about 4 to 8 weeks for spontaneous
resolution. This varies depending upon the amount of botox given and the
strength of the underlying muscles.

When
patients are unwilling to wait for spontaneous resolution, several options are
available. These include eye drops which partially reverse the impact of botox.
These include the eye drops alphagan and lopidine. Both are assoiaed with
excellent clinical responses and high levels of patient satisfaction.

Alphagan
is frequently used to treat this complicationof botox injections. This drug is
typically used to manage glaucoma, but can be used to treat a drooping eyelid
following botox injections. The drug works by stimulating the muller’s muscle
within the eyelid. It’s only contra indication is the use of monoamine oxidase
inhibitors.

If
you’ve developed eyelid sag following botox, it’s important to consult your
plastic surgeon. With these eye drops, this problem can usually be
satisfactorily addressed.

P. Daniel Ward, MD · Answer

Alphagan should be fine to use to help treat your droopy eye after Botox injection.  Thankfully, your droopy eyelid should return to its normal state in a few months.  Good luck!

Brian S. Biesman, MD · Answer

You should not worry about using alphagan for a while even if you do not have glaucoma. Some find that Iopidine is more effective but it is also more difficult to find. Alphagan can sometimes cause allergic reactions or irritation of the eye. If your eye becomes red, light sensitive, or uncomfortable discontinue use of alphagan.

Otto Joseph Placik, MD · Answer

Alphagan is an accepted remedy for blepharoptosis caused by unexpected Botox infiltration into the levator muscles.
Alphagan works by stimulating a second set of muscles called Muller's muscle which causes lifting of the eyelid muscle.
If it works then I would continue to use it. However, if it doesn't work, why keep using it?

David Shafer, MD, FACS · Answer

A drooping eyelid after Botox is a known, but very rare, temporary complication of Botox. This complication, however, must also be distinguished from drooping of the eyebrow, which causes a "fullness" in the upper lids - this is much more common than an actual ptosis (drooping) of the eyelid.
For true ptosis of the eyelid, drops do help.
It is okay to use Alphagan drops even if you do not have glaucoma. The only contra-indication to using Alphagan drops is if you are also taking a monoamine oxidase inhibitor. The reason that Alphagan drops and some other glacoma drops are used for droopy eyelids after Botox is that the drops stimulate a muscle in the eyelids which helps elevate them a millimeter or two. The lid elevation was first noted in patients taking the drops for glaucoma, but now the drops are also in common use for temporary relief of droopy lids after Botox.
For the patients that have be referred to me, I recommend Iopidine (Apraclonidine) Eye Drops. These drops work on a tiny muscle in your eyelid and help pull it up 1 to 3 mm. The drops must be repeated a few times a day for a continued effect. If you have drooping eyebrows leading to full eyelids, these eye drops will have no effect. This leads to the usual warning that you should only have Botox injected by an experienced person.
I hope this is helpful.

Michael A. Persky, MD · Answer

Hi DG1,
Sorry to hear that you are suffering from a droopy eye lid after Botox.  I have not heard of using Aphagan P (a glaucoma eye drop treatment) for your problem.  I have heard of using Visine eye drops that cause a vaso constriction, and help a little for a few hours.
Fortunately I have not had to advise my patients, but we recommend that the drops be used sparingly, and only if the patient has a social occasion where they want improvement for a few hours.  I will speak to our Allergan rep to see what the deal is with Alphagan.
Good luck, hopefully this resolves quickly for you.
Dr. P

Tim Sayed, MD, MBA, FACS · Answer

For a truly droopy eyelid, it does help and is safe. If it is not lifting the eyelid, you should discontinue the medication, as that would indicate that you have a droopy eyebrow that is causing the eyelid to droop, and that is not fixed with Alphagan drops.

Michele S. Green, MD · Answer

Droopy eye from Botox is a rare but annoying side effect from this kind of injection.  Alphagan P helps some patients with lifting the eyelid and appearing less droopy.  Always consult your treating physician for any contraindications.