Botulinum Toxin Treatment for Botulinum Toxin–Induced Blepharoptosis

Abstract

Blepharoptosis, or eyelid ptosis, is one of the most common significant potential side effects of botulinum toxin (BTX) injection and is defined as drooping of the upper eyelid. Botulinum toxin injection to the pre-tarsal orbicularis oculi muscle for the correction of upper eyelid ptosis. We reviewed 2 patients with mild upper eyelid ptosis following BTX injection. The patients received pre-tarsal BTX injections via a transdermal approach. Signed consent was obtained from the patients for the publication of their case details and images. Ptosis was evaluated by measuring marginal reflex distance (MRD) values before and 2 weeks after treatment. The efficacy of the treatment was defined by improvement of more than 1 to 2 mm difference in MRD between the 2 eyes. The BTX injection is hypnotized to work by weakening the pre-tarsal orbicularis selectively, tending toward a balance of force favoring retraction. Botulinum toxin application to the pre-tarsal orbicularis was effective in raising the upper eyelid ptosis induced by BTX injection.