Botox® after Botox® - a new approach to treat diplopia secondary to cosmetic botulinic toxin use: case reports

Abstract

A new technique for the treatment of diplopia secondary to cosmetic botulinum to xin A use is described. In this interventional case reports, two consecutive patients who developed diplopia after periocular cosmetic use of botulinum toxin A were treated with intramuscular botulinum toxin A injection into the antagonist ex traocular muscle. Diplopia resolved in both patients in less than 1 week with no side effects or complications. In conclusion, the injection of intramuscular botulinum toxin A is an encouraging option for treatment of diplopia secondary to botulinum toxin A use for facial lifting.

Randomized, double‐blind, active‐controlled, multicentre, phase III clinical trial with two stages to assess the safety and efficacy of letibotulinum toxin a vs. onabotulinum toxin a for subjects with moderate to severe crow's feet

“…In general, muscle weakness after botulinum toxin injections occurs 2–4 days later, and muscle recovery occurs within 3 to 4 months. However, diplopia after botulinum toxin injection is known to occur within days or weeks, and the recovery of symptoms typically occurs 1–2 months later 22,23 . Finally, re‐treatment (repeated injections) is one of the potential risk factors for diplopia after botulinum toxin use.…”

“…However, diplopia after botulinum toxin injection is known to occur within days or weeks, and the recovery of symptoms typically occurs 1-2 months later. 22,23 Finally, re-treatment (repeated injections) is one of the potential risk factors for diplopia after botulinum toxin use. Although she had also undergone other botulinum toxin treatments around the masseter muscle area and CFL (OnBA, Nabotaâ) 4 years previously, this interval is usually too long to be defined as retreatment.…”

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

“…Check visual acuity using a Snellen chart (Delle Chiaie, 2024; Gelb, 2022; Isaac et al, 2012; Shumway et al, 2023).…”

“…These factors include questioning the patient regarding any previous facial trauma, obtaining a comprehensive visual and ocular history, and evaluating any neurological considerations. Traumatic injury may damage the integrity of the facial musculature and adjacent structures, which may, in turn, influence how the neurotoxin interacts with the tissue (Delle Chiaie, 2024; Isaac et al, 2012). Conditions such as diplopia, strabismus, nystagmus, or irregularities in visual acuity may be indications of compromised ocular function or pre-existing muscle imbalance that can be exacerbated by neurotoxin administration and may enhance the potential for diffusion.…”

Complications of Toxins and Fillers and Evidence Based Protocols for Their Immediate, Short-Term and Long-Term Management

“…Double or blurred vision is a more serious complication in terms of functionality and quality of life. Opthalmological consultation is proposed in various reviews so that the ophthalmologist can choose between various treatment options: conservative management, use of ocular occlusion, glasses with prismatic lenses or use of BTX injection into the antagonist muscle [6].…”