title: Dry eyes and superficial punctate keratitis: a complication of treatment of glabelar dynamic rhytides with botulinum exotoxin A.
abstract: BACKGROUND
  Dry eyes and superficial punctate keratitis are potential complications of periocular botulinum exotoxin A treatment.
  
  
  OBJECTIVE
  To report a patient who had these side effects after being treated with botulinum exotoxin A for glabelar rhytides and discuss possible causes including excessive paralysis of the orbicularis oculi leading to lagophthalmos and direct paralysis of the lacrimal gland.
  
  
  METHODS
  A case report and brief literature review is presented.
  
  
  CONCLUSIONS
  Paralytic lagophthalmos caused dry eyes and superficial punctate keratitis in our patient. To avoid this complication, if an injection is to be done in the lateral brow area, it should be done 1 cm above the orbital rim.
authors.affiliation: Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0009, USA.
authors.forename: Marian Elizabeth
authors.initials: ME
authors.lastname: Northington
authors.forename: Conway C
authors.initials: CC
authors.lastname: Huang
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects*; D003357:Cosmetic Techniques / Q000009:adverse effects*; D003937:Diagnosis, Differential; D015352:Dry Eye Syndromes / Q000139:chemically induced / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects; D007634:Keratitis / Q000139:chemically induced / Q000175:diagnosis*; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015595:Skin Aging
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A