Management of Botox-Induced Eyelid Ptosis

Prevention and Treatment

The American Academy of Ophthalmology recommends avoiding manipulating the injection area to prevent further toxin spread, remaining upright for 3-4 hours after treatment, avoiding touching, rubbing, or massaging the treated areas, refraining from strenuous exercise for 24 hours, and avoiding alcohol consumption for 24 hours 1
Apraclonidine 0.5% ophthalmic drops are the primary treatment for eyelid ptosis caused by excessive Botox dosage, with a typical trial period of 1 week to determine if the patient is a responder 1
If ptosis is accompanied by diplopia, temporary occlusion (eye patch) may be helpful while waiting for resolution, and prisms (press-on or ground-in) can help manage diplopia 2, 3

The American Academy of Ophthalmology suggests that prisms (press-on or ground-in) can help manage diplopia in patients with Botox-induced ptosis, with a strength of evidence based on clinical experience 2, 3

Regular follow-up every 1-2 weeks until resolution is recommended to monitor for improvement in ptosis and visual function, and to assess for any complications or worsening symptoms 1

The American Society for Dermatologic Surgery recommends ensuring Botox injections are administered by qualified practitioners with experience in facial anatomy, using appropriate dosing and proper injection technique, avoiding injections too close to the orbital rim, and considering lower doses in high-risk areas 1