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Unilateral transient mydriasis and ptosis after botulinum toxin injection for a cosmetic procedure

Authors Akkaya S, Kökcen HK, Atakan T

Received 19 October 2014

Accepted for publication 11 December 2014

Published 12 February 2015 Volume 2015:9 Pages 313—315

DOI https://doi.org/10.2147/OPTH.S76054

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser


Sezen Akkaya,1 Hatice Kübra Kökcen,1 Tuğba Atakan2

1Fatih Sultan Mehmet Education and Training Hospital, Ophthalmology Clinics, Bostanci, Istanbul, 2Aksaray Hospital, Ophthalmology Clinics, Konya, Turkey

Abstract: We report a case of unilateral transient mydriasis and ptosis after botulinum toxin injection applied by a medical doctor for a cosmetic procedure. A 36-year-old nurse was referred to our eye clinic with unilateral mydriasis and ptosis in the right eye 3 days after botulinum toxin injection for a cosmetic procedure. Botulinum toxin was applied to her eye by a doctor at her hospital who was not an ophthalmologist. She was treated with topical apraclonidine 0.5% ophthalmic solution. Her ptosis decreased to 2 mm with apraclonidine and her visual axis improved. Mydriasis was present for 3 weeks and then disappeared. Mild ptosis continued for 3 months, then resolved completely. Patients seeking treatment with botulinum toxin A for cosmetic purposes should be warned about the possibility of ptosis and mydriasis after injection. If these side effects are seen, the patient must be referred to an ophthalmologist for appropriate management.

Keywords: botulinum toxin, mydriasis, ptosis


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