title: Variable ptosis after botulinum toxin type a injection with positive ice test mimicking ocular myasthenia gravis.
abstract: We describe a patient who received cosmetic botulinum toxin type A injections to the brow and subsequently developed unilateral ptosis that was variable during examination and was transiently improved after the ice pack test. Ptosis gradually resolved spontaneously over approximately 3 months. This is the third patient to have variable ptosis documented after botulinum toxin type A injection to the brow and the second to have a positive ice test. The ice test is not completely specific for myasthenia gravis but may, at times, improve ptosis resulting from other defects at the neuromuscular junction. Wound botulism now is much more common because of illicit drug use, and the ice test also might be positive in this setting.
authors.affiliation: Department of Ophthalmology, College of Medicine, Qassim University, Buraidah, Saudi Arabia.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Alaraj
authors.forename: Darren T
authors.initials: DT
authors.lastname: Oystreck
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Bosley
mesh_terms: D001763:Blepharoptosis / Q000139:chemically induced*; D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007053:Ice; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000503:physiopathology*
chemical_list: D007053:Ice; D019274:Botulinum Toxins, Type A