Botox Side Effects

There have been reports of seven cases of diffuse skin rash and two cases of local swelling of the eyelid skin lasting for several days following eyelid injection.

Inducing paralysis in one or more extraocular muscles may produce spatial disorientation, double vision, or past-pointing. Covering the affected eye may alleviate these symptoms. Extraocular muscles adjacent to the injection site are often affected, causing ptosis or vertical deviation, especially with higher doses of Botox (Butulinum Toxin Type A) Purified Neurotoxin Complex. The incidence rates of these side effects in 2058 adults who received 3650 injections for horizontal strabismus are listed below:

Ptosis 15.7%
Vertical deviation 16.9%

The incidence of ptosis was much less after inferior rectus injection (0.9%) and much greater after superior rectus injection (37.7%).

The incidence rates of these side effects persisting for over six months in an enlarged series of 5587 injections of horizontal muscles in 3104 patients are listed below:

Ptosis lasting over 180 days 0.3%
Vertical deviation greater than 2 prism diopters lasting over 180 days 2.1%

In these patients, the injection procedure itself caused nine scleral perforations. A vitreous hemorrhage occurred and later cleared in one case. No retinal detachment or visual loss occurred in any case. Sixteen retrobulbar hemorrhages occurred. Decompression of the orbit after five minutes was done to restore retinal circulation in one case. No eye lost vision from retrobulbar hemorrhage. Five eyes had pupillary change consistent with ciliary ganglion damage (Adies pupil).

Blepharospasm

In 1684 patients who received 4258 treatments (involving multiple injections) for blepharospasm, the incidence rates of adverse reactions per treated eye are listed below:

ptosis 11.0%
Irritation/Tearing (includes dry eye, lagophthalmos, and photophobia) 10.0%
Ectropion, keratitis, diplopia and entropion were reported rarely (incidence less than 1%) <1%
Ecchymosis occurs easily in the soft eyelid tissues. This can be prevented by applying pressure at the injection site immediately after the injection.
In two cases of VII nerve disorder (one case of an aphakic eye) reduced blinking from Botox Purified Neurotoxin Complex injection of the orbicularis muscle led to serious corneal exposure, persistent epithelial defect and corneal ulceration. Perforation requiring corneal grafting occurred in one case, anaphakic eye. Avoidance of injection into the lower lid area to avoid ectropion may reduce this hazard. Vigorous treatment of any corneal epithelial defect should be employed. This may require protective drops, ointment, therapeutic soft contact lenses, or closure of the eye by patching or other means.
Two patients previously incapacitated by blepharospasm experienced cardiac collapse attributed to over-exertion within three weeks following Botox Purified Neurotoxin Complex therapy. Sedentary patients should be cautioned to resume activity slowly and carefully following the administration of Botox.

Botox Side Effects

Botox Information