In aesthetic medicine, botulinum toxin is used to solve a number of problems. One of the possible side effects of botulinum toxin administration is ptosis of the upper eyelid due to penetration of the drug into the levator levator muscle of the upper eyelid. This side effect occurs in about 1% of cases and may occur within two weeks after injection due to improper administration of the drug or the anatomical features of the patient. In this case, ptosis after botulinum toxin can persist for up to 3 months. How to solve this problem, says Dr. Zahida Butt (Zahida Butt) – Oculoplasty Surgeon and Ophthalmologist at Queen Elizabeth Hospital, King's Lynn (England).
Iopidine for upper eyelid ptosis after Botox injections
In some cases, for the treatment of ptosis of the upper eyelid after the introduction of botulinum toxin, 0.5% - 1% apraclonidine (Iopidine) is used: 1–2 drops 3 times a day until the blepharoptosis is eliminated.
Iopidine – it is an adrenergic agonist that selectively elevates the upper eyelid in case of dysfunction of the muscle that lifts the upper eyelid, as a result of the administration of botulinum toxin preparations. Iopidine acts on adrenergic alpha-2 receptors in smooth muscle, which leads to contraction of the Müllerian muscle. This muscle is connected to the muscle that lifts the upper eyelid, and when contracted, it allows you to lift the eyelid by 1–3 mm.
Treatment of ptosis of the upper eyelid after botulinum toxin injection: 1–2 drops 3 times a day until the ptosis is eliminated.
It is very important to distinguish between brow ptosis associated with the injection of too much botulinum toxin into the frontalis muscle and ptosis of the upper eyelid (see video):
Ptosis of the upper eyelid
Eyebrow ptosis
If apraclonidine is used to correct ptosis of the eyelid after Botox, the following should be considered:
- side effects of the drug;
- possible contraindications.
Side effects of Iopidine
In addition to the desired result – elimination of ptosis after botulinum toxin injections, Iopidine can also cause side effects. In the case of using a 1% solution, approximately 20% of patients experience hypersensitivity, including:
- a feeling of discomfort;
- hyperemia;
- itching;
- lacrimation;
- dry eyes;
- dry mouth;
- redness of the eyelids and conjunctiva;
- arrhythmia.
A study involving 40 patients showed that when Iopidine was used for 90 days, allergic reactions occurred mainly 30-60 days after the start of use and disappeared after discontinuation of the drug.
The following side effects were observed in less than 1% of cases: crusting at the edge of the eyelid, conjunctival folliculitis, blurred vision, keratitis, blepharitis, photosensitivity, irritation, etc.
Some patients (less than 3%) may experience arrhythmia, peripheral edema and irregular heartbeat, incoordination, dizziness, headaches, fatigue, contact dermatitis, parosmia, dysgeusia.
Contraindications for the use of Iopidine to eliminate ptosis after Botox injections
Serious side effects after using the drug are extremely rare, however, in order to avoid them, it is necessary to study the patient's medical history before prescribing Iopidine and be careful in case of:
- renal failure;
- depression;
- recently experienced heart attacks;
- high blood pressure;
- heart failure;
- angina pectoris;
- vasovagal crisis.
With caution, Iopidine is prescribed when taking monoamine oxidase inhibitors and tricyclic antidepressants, in case of hypersensitivity or allergy to certain ingredients of the drug.
Serious side effects after the use of the drug are extremely rare, however, in order to avoid them, it is imperative to study the patient's medical history and exercise caution before prescribing Iopidine.
Often blurred vision occurs after the use of Iopidine, in which case patients are advised not to drive a car or work with any equipment until this side effect is eliminated.
Also, the doctor should warn the patient about the possibility of dizziness, fatigue and increased side effects in case of alcohol consumption.
Ptosis of the upper eyelid after the introduction of Botox resolves on its own, even without treatment, after about 2-4 months. Treatment of ptosis after Botox with 0.5% - 1% Iopidine solution can significantly reduce the severity of ptosis and accelerate the elimination of this side effect of botulinum toxin administration.
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