Double vision due to lateral rectus injury after cosmetic botulinum toxin injections

Abstract

Facial intramuscular injections of Botulinum toxin (BoNT) injections are among the most common cosmetic procedures in dermatology. Rarely, serious adverse reactions such as blepharoptosis, diplopia and periorbital hematoma may occur with improper administration technique. Here we report a case of painless diplopia 5 weeks post‐BoNT injection for ‘crow's feet’ likely due to inadvertent BoNT diffusion into the lateral rectus muscle causing a temporary palsy. This case aims to raise awareness of proper cosmetic BoNT injection techniques in the periorbital area to avoid ophthalmic complications.

Prevention, Diagnosis, and Management of Diplopia Secondary to Neurotoxin Injections

“…This will reduce the potential for the neurotoxin to diffuse through the orbital septum (Delle Chiaie, 2024; Witmanowski & Błochowiak, 2020). Khan et al (2023) suggested that if a neurotoxin is inadvertently injected into the arteries supporting the lateral canthus it could allow diffusion of the toxin into the extraocular muscles, via the vascular system.…”

“…In most cases, the diplopia is caused by a weakened extraocular muscle. When the diplopia is accompanied by a palsy, it is generally caused by a complete paralysis of the involved muscle (Delle Chiaie, 2024; Khan et al, 2023; Scott et al, 2023).…”