By Dr Tim Pearce, MBChB BSc (Hons) MRCGP
How to assess and treat a client complaining of eyelid ptosis after a botox treatment.
Ptosis of the eyelid has a published rate of 1/100 treatments of botulinum toxin.
It is thought to be caused by migration of botox either from lateral corrugator injection, or from the superior orbicularis injection.
In practice many clients who complain of it actually have a brow ptosis rather than a true lid ptosis. A brow ptosis mimics a lid ptosis when it is present in conjunction with loose skin above the eyelid, which is pushed down from above. The test is to look at the line of the eyelid and the position that it crosses the iris. Asymmetry is usually not affected at this point, rather it is evident above- nearer the eyebrow. Gentle lifting of the brow to see if the lid is lifted is also helpful.
The main use of this is examination is to help you decide whether aproclonidine drops will be useful or not.
Aproclonidine is a sympathomimetic, so widens the eye by stimulating smooth muscle in the lid, as would occur during a fight or flight response. It has a short half life, and needs to be applied between 2 and three times a day if the patient is suffering with the aesthetic result or it is crossing the visual axis.
Many lid ptosises are actually very mild, do not affect function, and are not that aesthetically too disturbing, so it may not always be worth the use of aproclonidine- this is of course highly subjective.
If you do feel the drops would be useful, prescribe them to be applied only to the affected eye, 2 drops twice a day, 3 times if required. The effect should be near instant with a true ptosis, but it will only lift the lid a modest 2mm on average.
Most ptosis recover quickly, after around 6 weeks regardless of management.
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