Eyelid ptosis following botulinum toxin injection treated with apraclonidine 0.5% drops

Botulinum toxin injections are among the most commonly performed procedures in aesthetic medicine due to their efficacy in reducing dynamic facial wrinkles. Although generally safe, the most frequent complication following treatment of the glabellar and forehead regions is eyelid ptosis, which typically develops 2–10 days after injection and may persist for 2–4 weeks. Pharmacological management with α-adrenergic agonists represents the mainstay of treatment. Apraclonidine 0.5% ophthalmic solution, a selective α2-adrenergic agonist, stimulates Müller’s muscle and produces rapid, temporary eyelid elevation. Topical brimonidine gel has also been reported as an effective alternative, offering a favorable systemic safety profile. Clinical studies, though relatively scarce, support the use of these agents for symptomatic relief of botulinum toxin–induced ptosis.

We report a case of a 39-year-old female who developed unilateral right eyelid ptosis four days after botulinum toxin type A injection for glabellar and forehead lines. Following treatment with apraclonidine 0.5% drops twice daily, the patient demonstrated progressive improvement, with complete resolution of ptosis after six weeks.

Proper injection technique, including placement lateral and medial to the mid-pupillary line and directing the needle away from the midline, remains essential to minimize the risk of ptosis. Overall, α-adrenergic agonists provide a safe, effective, and practical therapeutic option for the temporary management of botulinum toxin–induced eyelid ptosis.