The role of botulinum toxin in correcting frontalis-induced eyelid pseudo-retraction post ptosis surgery

Indian J Ophthalmol. 2007 Jul-Aug;55(4):307-8. doi: 10.4103/0301-4738.33049.


We report a case of a 52-year-old female patient who developed overcorrection, due to brow overuse, post surgery for bilateral aponeurotic ptosis. The patient had undergone levator palpebrae superioris plication bilaterally. Due to brow overuse habituated by long standing ptosis, the patient presented with superior scleral show, post ptosis surgery. The lid contour was normal in both eyes and when brow overaction was blocked mechanically, the palpebral fissure heights were normal, comparable, with no scleral show bilaterally. Despite repeated instructions, when the patient continued brow overuse subconsciously, an injection of botulinum toxin was given just above both brows. This led to elimination of brow overuse within a month, with elimination of superior scleral show. The patient maintained lid and brow symmetry with no overaction, eight months post injection.

Publication types

  • Case Reports

MeSH terms

  • Blepharoplasty / adverse effects*
  • Blepharoplasty / methods
  • Blepharoptosis / surgery*
  • Botulinum Toxins, Type A / administration & dosage*
  • Ectropion / drug therapy*
  • Ectropion / etiology
  • Facial Muscles / drug effects
  • Facial Muscles / physiopathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intramuscular
  • Middle Aged
  • Muscle Contraction / drug effects
  • Neuromuscular Agents / administration & dosage*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A