From the Guidelines
Botulinum toxin (Botox) can be used to open up the eyes by relaxing specific muscles around the eyelids, with the most recent and highest quality study suggesting its effectiveness in yielding long-term improvement in ocular alignment 1. The procedure involves injecting small amounts of Botox into the orbicularis oculi muscle, which encircles the eye and is responsible for eyelid closure. Some key points to consider when using Botox for this purpose include:
- Typically, 2-5 units of Botox are injected at multiple points along the upper and/or lower eyelids, with effects lasting 3-4 months before requiring repeat treatment.
- This treatment works particularly well for conditions like blepharospasm (involuntary eyelid spasms), ptosis (droopy eyelids), or to create a subtle lifting effect for cosmetic purposes.
- Botox functions by blocking the release of acetylcholine, the neurotransmitter that signals muscles to contract, thereby temporarily paralyzing the targeted muscles and reducing their ability to close the eye fully.
- The procedure is quick (usually under 15 minutes), minimally invasive, and requires no downtime, though patients may experience temporary bruising, dryness, or rarely, asymmetry.
- It's essential to have this procedure performed by an experienced ophthalmologist, oculoplastic surgeon, or dermatologist to ensure proper placement and dosing for optimal results while minimizing side effects, as supported by the most recent study on adult strabismus preferred practice pattern 1.
From the Research
Botulinum Toxin for Eye Area
To open up the eyes using botulinum toxin (Botox), the treatment typically involves injecting the toxin into specific muscles around the eye area. The goal is to relax these muscles, thereby reducing wrinkles and widening the eye.
Mechanism and Effectiveness
- Botulinum toxin type A (BTX-A, BOTOX) is used to improve wrinkles by relaxing the muscles of facial expression, including those around the eye area 2.
- The treatment can be used in the lower eyelid to improve wrinkles and widen the eye, with studies showing an increase in palpebral aperture (IPA) in all subjects 2.
- The dose-response curve shows that increasing doses of BTX-A can increase eye widening, but higher doses may also lead to unattractive results and side effects 2.
Safety and Side Effects
- Common side effects of botulinum toxin injections around the eye area include lower eyelid edema, incomplete sphincter function, and diplopia (double vision) 2, 3, 4.
- The risk of adverse events is higher when treating areas around the eyes, and practitioners should be cautious when injecting botulinum toxin for cosmetic purposes 4.
- However, studies have also shown that botulinum toxin therapy can be safe and effective for eye muscle disorders, with no systemic toxic reactions reported in over 8,800 patients 5.
Treatment Techniques
- The recommended dose for botulinum toxin injections in the lower eyelid is 2-4 U, with higher doses potentially leading to more side effects 2.
- The treatment can be combined with injections in the lateral orbital area to produce a synergistic response, but higher doses may lead to a plateau effect 2.
- Techniques for injecting botulinum toxin around the eye area should be carefully considered to minimize the risk of side effects and optimize the treatment outcome 2, 5.