Management of Severe Botulinum-Induced Eyelid Ptosis With Pre-tarsal Botulinum Toxin and Oxymetazoline Hydrochloride 0.1.

Abstract

Eyelid ptosis following periocular onabotulinumtoxinA (BoNT-A) treatment is a known complication which can be frustrating for both patients and practitioners. Iatrogenic blepharoptosis occurs due to local spread of the BoNT-A from the periocular region into the levator palpebrae superioris muscle; while injectors should have a thorough understanding of the relevant anatomy in order to prevent it, BoNT-A induced ptosis can occur even in the most experienced hands. To describe a case series of patients effectively treated with Oxymetazoline HCl 0.1% and pre-tarsal BoNT-A injections in the setting of botox-induced ptosis. Eight patients were included who underwent recent cosmetic BoNT-A treatment preceding the sudden onset of unilateral upper eyelid ptosis. A diagnosis of severe ptosis (>3 mm) was made in all the cases in this series. Pre-tarsal BoNT-A injections alone or in association with topical administration of Upneeq eyedrops (Upneeq, Osmotica Pharmaceuticals, Marietta, GA) significantly reversed the ptosis in all treated cases. This is the first documented case series of patients effectively treated with Oxymetazoline HCl 0.1% and pre-tarsal BoNT-A injections in the setting of botox-induced ptosis. This treatment combination is a safe and effective option in these cases.