Ophthalmic adverse events following facial injections of botulinum toxin A: A systemic literature review

Abstract

Background Over the years, botulinum toxin has found its place as a neuromuscular blocking agent in numerous medical fields. Since the approval of botulinum toxin by the FDA for cosmetic indications in 2002, it had become the most commonly performed esthetic procedure worldwide, with ever‐growing demand. The characteristics of the toxin, along with the facial areas it is injected to, could possibly account for a wide array of complication. Methods The authors conducted a literature search for reported cases of ophthalmic adverse events following Botulinum toxin facial injections in the electronic databases of PubMed and Cochrane Library databases. Results The authors found 25 publications, reporting 49 cases of ophthalmic adverse events following botulinum toxin injections. Injections for cosmetic indications accounted for 51% of all injections, treatment of blepharospasms for 22% of cases, protective ptosis for 11% of cases, and treatment of hemifacial spams for 8% of cases. The average quantity of botulinum toxin injected to a single patient ranged between 1.25 and 75 units, with a median of 13.75 units.Majority of injections for cosmetic indications were performed to the lateral canthal area (56%), followed by the glabella (28%) and the forehead (20%).Adverse events following injections included diplopia (64%), ptosis (14%), and decrease in visual acuity or vision loss (8%). Conclusions Botulinum toxin is gaining extreme popularity in the management of a wide area of diseases and for cosmetic indications. Proper knowledge of potential adverse events is crucial for the clinician in attempt to decrease complications.

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

“…dose 21 total units), 50% were medical BoNT injections and 50% were cosmetic BoNT injections, indicating a similar risk in both cases. 10 The most common areas for cosmetic injection were the lateral canthal area, glabella and forehead regions. Diplopia following BoNT injection was reported anywhere between 3 and 60 days after injection (mean 15 days) and the majority of BoNT-induced diplopia cases completely resolved within 1-12 weeks, with only two cases citing partial resolution.…”

Management Options for Linear Scleroderma (“En Coup de Sabre”)

“…As a result, muscle fibers become functionally deinnervated, potentially leading to muscle atrophy and flaccid paralysis. 24…”

“…As a result, muscle fibers become functionally deinnervated, potentially leading to muscle atrophy and flaccid paralysis. 24 In recent years, the use of BTX has gained popularity in the management of dermatological diseases and their aesthetic appearance. Off-label use of the toxin include cases of hypertrophic scars, rosacea, postherpetic neuralgia, pruritus, and psoriasis.…”

Using Deep-Learning Algorithm to Determining safe areas for Injecting Cosmetic Fluids into The Face: A survey

“…Botulinum toxin has long been employed in various medical sectors as a neuromuscular organ-blocking agent. After the Food and Drug Administration (FDA) approved botulinum toxin for cosmetic use in 2002, it quickly became the most well-known cosmetic surgery in the world [17].…”