Possible eye dysfunction from Botox.

I have not had it happen but injected someone yesterday and realized afterward I was a little too close to their orbital rim. This was on the lateral aspect of the eye and the total amount of units injected was 6. I woke up at 3am with a panic attack thinking I was too close to her eye and now she will have Diplopia or some other side effect. Any thought?

Thanks

How close to the orbital rim?

I inject about 1 cm is a good rule. Or just before you feel the bone curving into the socket. Go outside that.

I personally have not heard of any problems with it.

Also, remember that botox is temporary.

I know of several docs who have given patinets different levels of problems but all resolved once the botox wore off.

Diplopia was seen as a rare side effect when injection for blepharospasm. So if you injected into the eye lid itself it is possible. It lasts a few days.

Ptosis may happen if some of the adjacent extraoccular muscles get botox. I believe it also is temporary because you are causing paralysis to the adjacent musculature.

Doc,

Don't worry. I inject the lower lid all the time using 2 to 3 units. I will even inject the lower lid at the midpupillary line. It gives a little more show of the white of the eye and gives a more open appearance. I have never seen issues with it. Big thing is to remain relatively superficial when injecting the eyes. Remember that the orbicularis oculi is fairly superficial.

Thank you all for your input. I have not yet heard from that particular patient so I assume all is ok. I would expect problems sooner that later in that area...

One side note: You do have to have little concern with injecting the lower lid in the group of people with poor pre-existing lower lid tone - scleral show, malar hypoplasia, poor snap back test, etc. Examine for these things before injecting....as the botox can knock out the muscular sling effect, and give you a little lid malposition. I've seen it, and it's well-described by the oculoplastics types. In those cases, it's better for the patients to keep their wrinkles!

TF,

Excellent point. My statement is assuming normal anatomy.

Also, if you are going to inject the lower lid at the mid-pupillary line only use 1 to 2 units. When injecting the lateral lower lid then go ahead and use 2 to 3 units but always start with only 2 units the first time. You will inject about 4 to 5 mm inside the orbital rim.

I AM the patient who's orbital rim you nearly penetrated with botox! Since the procedure,I've had trouble seeeeing. Does anyone here know a good medical claims lawyer?