Updated: Oct 14, 2020
One potential complication of botulinum toxin is eyelid droop, or ptosis. This occurs when the medicine inadvertently effects the small muscle that raises the eyelid. Prevention of ptosis requires care during injection and in the post-procedure period. (No rubbing!) When injecting botulinum toxin, the physician should be careful not to inject the lower frontalis or orbicularis oculi muscles lateral to the mid-pupillary line. The needle should be pointing superiorly away from the orbit. Expert knowledge of injection anatomy is key to avoid these landmarks; however, migration of the medication remains a potential risk.
A prescription eyedrop, apraclonidine, will successfully lessen the ptosis when used on a daily basis. Apraclonidine is an alpha-adrenergic receptor agonist which stimulates the sympathetic nerves of the superior tarsal muscle, decreasing the droop. Eyelid ptosis can be expected to fade over the next 3 weeks and be completely resolved after 3 months when the botulinum toxin wears off.