Oculofacial Plastics Practice of Dr. Kimberly Cockerham
Botox for Double Vision

BOTOX For Double Vision

Botox can be an effective treatment for some causes of double vision (called diplopia). Double vision can be in one eye only (monocular diplopia) or when both eyes are used together (binocular diplopia). Monocular diplopia most commonly results from dry eyes, the wrong eyeglass prescription, or cataracts.

Binocular diplopia can be caused by a number of conditions affecting the nerves or muscles of the eye. The most common condition is a stroke to a muscle of the eye. Patients will note a sudden onset of double vision, which is painless and persistent. There are certain patients who are at increased risk for an eye stroke. Those include:

  • 65 years of age and older
  • High blood pressure
  • High cholesterol
  • Diabetes

Other causes of binocular diplopia include thyroid eye disease and myasthenia gravis. In thyroid eye disease, certain muscle of the eye become enlarge and tight. In myasthenia gravis, circulating antibodies prevent the nerve from correctly communicating with the eye muscles.

In all of these conditions, Botox is injected into the “strong” muscle. This “rebalances” the eye muscles, thus improving the double vision. There are a few risks associated with botox injections into the eye muscle. These include persistent double vision, need for further injections, redness in the white of the eye, and eyelid dropping. These typically are temporary symptoms and will resolve on their own.


What is BOTOX

BOTOX is a purified protein that is synthesized from the naturally occurring bacterium, Clostridium botulinum. There are seven known forms, which are similar but have distinct structures. The most commonly used are:

  • Botox, botulinum A (Allergan)
  • Dysport, botulinum A (Medicis)
  • Xeomin, botulinum A (Merz)
  • Myobloc, botulinum B (Elan)

Botox is most commonly used for Cosmetic Artistry. However, Botox is also an effective treatment for a number of medical conditions including eyelid and facial spasms, eyelid retraction (thyroid eye disease, facial nerve dysfunction), drooping eyelids, inturning of eyelids, and double vision.

The effects of Botox typically lasts weeks to months before it wears off. Over time the nerves that are affected by Botox recover and form new nerve endings. It is also possible that there is deactivation of the toxin itself. It is known that multiple injections are more effective than increasing the volume of the injection.

Bruising is the most common unwanted side effect of Botox injection. In order to minimize bruising there are a number of medications that patients should avoid two weeks prior to injection. These include:

  • Aspirin, motrin
  • Fish oil – Omega 3
  • Flaxseed
  • Vitamin C and E
  • Garlic tablets

Additionally, there is an herbal supplement called Arnica Forte, which can decrease bruising. This is taken by mouth and should be started two days prior to injection.

Other less common risks of Botox include numbness, double vision, drooping eyelids, headaches, flu-like symptoms, muscle weakness and death.

American Academy of Cosmetic Surgery
Talk of the Town
American Academy of Opthalmology
Best of 209 Magazine 2020
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