PTOSIS SECONDARY TO BOTOX INJECTION IN THE MANAGEMENT OF FACIAL PAIN WITH MIGRAINE

Konstantinos Booras

Abstract

BACKGROUND: The Clostridium botulinum A exotoxin, or Botox A, is thought to be the most potent toxin known to man. In the past decade Botox has been found to be useful in the management of many muscular contraction syndromes including ophthalmic conditions such as blepharospasm, hemi-facial spasm, strabismus, and nystagmus, as well as non-ophthalmic uses for cosmesis and migraine pain management. Adverse ocular effects of the injection include persistent rash, localized anaphylactic reaction, and as we will discuss eyelid ptosis. Mechanisms of action include the reversible inhibition of acetylcholine-innervated muscle contractions and the inhibition of neurogenic inflammation believed to play a role in the etiology of headache disorders.

CASE REPORT(S). This case report will discuss an atypical presentation of ptosis associated with the use of Botox injection for facial pain and migraine. A 55-year-old white female was referred from the urgent care clinic for complaints of decreased vision in the left eye associated with a drooping and aching upper lid of approximately one day duration. Five days earlier, the patient received a Botox injection to the upper left brow area for a long-standing medical history of left-sided facial pain with migraine. The remainder of her ocular examination was unremarkable and consultation was obtained with the treating physician.

CONCLUSIONS. Unilateral ptosis with concurrent pain presenting relatively late after Botox injection should lead the optometrist to a careful assessment of its etiology. Entities such as painful Horner’s syndrome and incomplete ophthalmoplegic palsies should be ruled out meticulously. The differential diagnosis of and natural history of ptosis-complicating Botox injection will be discussed as well as the mechanism of action of Botox, its use in ophthalmic and non-ophthalmic practice, and the ocular complications associated with its use.

Details

Year: 2001

Program Number: Poster 70

Author Affiliation: Boston Veterans Affairs Healthcare System

Co-Authors: Barry Fisch, Robert Parks, Elina Goman Baskin, Jennifer Devita

Co-Author Affiliation: Boston Veterans Affairs Healthcare System, Boston Veterans Affairs Healthcare System, Boston Veterans Affairs Healthcare System, Boston Veterans Affairs Healthcare System

Room: Exhibit Hall C