Three Cases of Esotropia after Cosmetic Botulinum Toxin A Use in the Eyelid

Jae Jung Lee; Hye Shin Jeon; Hee Young Choi

doi:10.3341/jkos.2015.56.5.799

Journal List > J Korean Ophthalmol Soc > v.56(5) > 1010287

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Lee, Jeon, and Choi: Three Cases of Esotropia after Cosmetic Botulinum Toxin A Use in the Eyelid

Original Article

J Korean Ophthalmol Soc 2015;56(5):799-802.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.5.799

Three Cases of Esotropia after Cosmetic Botulinum Toxin A Use in the Eyelid

Jae Jung Lee, MD, Hye Shin Jeon, MD, Hee Young Choi, MD, PhD

¹Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

￭Address reprint requests to Hee Young Choi, MD, PhD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7324, Fax: 82-51-242-7341 E-mail: hychoi@pusan.ac.kr

Received 16 January 20154 February 2015 Accepted 23 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

We report three cases of esotropia after botulinum toxin A injection in the eyelid for esthetic purposes.

Case summary:

Esotropia was observed in three patients presented with diplopia after botulinum toxin A application in the eyelid for esthetic purposes. (Case 1) A 51-year-old woman developed diplopia, mild ptosis and hyperemia in both eyes after periocular cosmetic use of botulinum toxin A 6 weeks before. In the primary position, the angle of esotropia was 10 prism diopters (PD) at distance and 6 PD at near. She had slightly limited abduction and mild ptosis on both eyes. (Case 2) A 50-year-old woman developed diplopia after botulinum toxin A injection in the upper eyelid 15 days prior. In primary position, the angle of esotropia was 18 PD at distance and 12 PD at near. She had slightly limited abduction and mild ptosis in both eyes. (Case 3) A 40-year-old woman was examined with diplopia after botulinum toxin A injection in the crow’s feet and lower lid 6 days earlier. In primary position, the angle of esotropia was 30-35 PD at distance and 18 PD at near. She had slightly limited abduction. Prism glasses were prescribed for patients in case 1 and case 3. All three patients were resolved in symptoms of diplopia, gaze limitation and ptosis after 1 or 2 months.

Conclusions:

Botulinum toxin A could spread out from the lateral canthus to both lateral rectus muscles and cause a transient paresis of the muscles. This was presented as esotropia and the mild abduction deficits on both eyes. We suggest that patients presenting with diplopia should be asked if they have a history of injection of botulinum toxin A and patients should be fully informed about the complications of botulinum toxin A before injection.

Keywords: Botulinum toxin A, Diplopia, Esotropia

References

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Figure 1.

The patient of case 1 showed esotropia after botulinum toxin A injection for crow’s feet treatment and resolved in symptoms after 2 months. (A) Nine cardinal gaze photographs taken 6 weeks after injection of botulinum toxin A showing approximately 10 prism diopters (PD) of esotropia. (B) Lancaster red-green test showed slightly limited abduction on both eyes. (C) Nine cardinal gaze photographs taken 2 months after using the 3 PD base out prism on her both spectacle lenses showing normal ocular motility. (D) There was no gaze limitation on both eyes after 2 months after injection of botulinum toxin A. O.S. = left eye; O.D. = right eye.

Table 1.

Cases description, start of diplopia, performed treatment and recovery of symptoms

	Start of diplopia^*	Injection site of botulinum toxin A	Eyelid ptosis	Treatment performed	Improvement of diplopia^†
Case 1	42 days	Crow’s feet, lower lid	Present	Base-out 3 PD glasses	2 months
Case 2	15 days	Upper lid	Present	Observation	1 month
Case 3	6 days	Crow’s feet, lower lid	Absent	Base-out 5 PD glasses	2 months

PD = prism diopters.

^* Days after botulinum toxin A application for esthetic purposes;

^† Months after botulinum toxin A application for esthetic purposes.

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