There is currently no treatment for botulinum toxin-induced ptosis. Patients suffering from such a complication have to wait several weeks until the effects of the toxin disappear. This case report suggests that apraclonidine may provide a reversal option for doctors and their patients. When Botox migrates to one or both specific areas, Botox injections can cause a droopy eyelid, also called ptosis.
Stimulating affected muscles can help reduce the amount of time it takes for Botox to dissolve. You can do this by exercising the fallen muscle or by electrical stimulation. When inexperienced Botox practitioners try to smooth out all the forehead lines with Botox and don't understand why those lines are there to begin with, they involuntarily cause the eyebrows to collapse into the eyelid space and make those eyelids look very heavy. It is not really a true ptosis, but it occurs due to decreased frontal muscle function after Botox injection.
The best treatment option for these cases is cosmetic eyelid surgery “blepharoplasty” to remove all excess eyelid skin. Finally, if ptosis is causing vision restriction, it may be necessary to bandage the forehead or eyelid to remove it from the field of vision. Ask your regular doctor for a referral or find one who is an expert in your condition and how to administer Botox and other neurotoxin treatments. Before treatment, be sure to tell your doctor if you have received any of these injections in the past 4 months.
The most common negative reaction to injections in the face is a drooping eyelid, also called ptosis or blepharoptosis. There is no specific treatment for this complication and it usually resolves within weeks; however, if an ectropion develops, an immediate ophthalmic shunt is recommended to avoid exposure to keratitis and corneal damage. Sometimes ptosis is subtle and may not be immediately apparent, but the patient will feel that the eyelid or eyebrows feel heavy and may not be able to fully open the eye and may have difficulty applying eye makeup. As a defense mechanism, these women will unconsciously raise their eyebrows to combat sagging eyelids and improve the field of vision.
Next, evaluate the patient's anatomy and musculature, pay special attention to the position of the eyebrows (the anatomical forehead instead of the actual eyebrows, which may have been cosmetically altered) and any pre-treatment asymmetry (approximately 90% of the population has a degree of eyebrow asymmetry). This occurs as a result of the migration of the toxin to the muscle that elevates the eyelid (levator muscle of the upper eyelid, pink in the image). Inform the patient to avoid sunbathing, saunas and massages after treatment for at least four hours, as these activities may cause further spread of the toxin. If ptosis persists, it would be wise to consider referral to a doctor who has more experience in this area.
When injected intradermally rather than intramuscularly when treating the forehead, one study reported a lower incidence of ptosis with no reduction in results. To avoid ptosis, injections should be done at least 1 cm above the eyebrow and should not cross the midline of the pupil. A side effect of botulinum toxin injection into the upper third of the face is ptosis or drooping of the eyelid. If upper eyelid ptosis requires treatment, 0.5% apraclonidine eye drops may be prescribed in a dose of 1 to 2 drops three times a day.
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