title: Persistence of Upper Blepharoptosis After Cosmetic Botulinum Toxin Type A.
abstract: BACKGROUND
  Upper eyelid ptosis after cosmetic botulinum toxin is generally considered short-lived and responsive to apraclonidine ophthalmic drops. The authors present a series with persistent ptosis.
  
  
  OBJECTIVE
  To report a series of patients with persistent upper eyelid ptosis after cosmetic botulinum toxin.
  
  
  METHODS
  A retrospective case review series of 7 patients referred for management after developing visually significant upper eyelid ptosis after cosmetic botulinum toxin type A treatment.
  
  
  RESULTS
  Patients in this series experienced persistent visually significant ptosis after cosmetic botulinum toxin lasting from 6 weeks to 13 months. Six of the 7 patients were treated with apraclonidine ophthalmic solution. Apraclonidine drops appeared to be clinically effective within 4 to 6 weeks of the resolution of ptosis.
  
  
  CONCLUSIONS
  Upper eyelid ptosis after cosmetic botulinum toxin can persist for many months after treatment. Based on this series, the authors propose that apraclonidine drops can be used at the time of initial assessment to predict the relative longevity of ptosis after cosmetic botulinum toxin treatment (Level 4 evidence recommendation). After a 1-week trial, responders can be advised that ptosis is likely to resolve in 4 to 6 weeks. Nonresponders should be counseled that resolution may take longer than 6 weeks.
authors.affiliation: *All the authors are affiliated with the Division of Ophthalmic Plastic and Reconstructive Surgery, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Steinsapir
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Groth
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Boxrud
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D001763:Blepharoptosis / Q000139:chemically induced* / Q000188:drug therapy; D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D003000:Clonidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005143:Eyelids / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000009:adverse effects*; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D009465:Neuromuscular Agents; D009883:Ophthalmic Solutions; C016986:apraclonidine; D019274:Botulinum Toxins, Type A; D003000:Clonidine