Conditions like blepharospasm, strabismus, drooping eyelids (ptosis), excessive eye watering (epiphora), and migraines can all benefit from routine Botox injections as one approach to treatment. Like any medical treatment, there are some risks and side effects associated with Botox injections, but these are rare.
Medical use of Botox will receive some insurance coverage, but cosmetic use will not be covered. Botox prices generally range from $10 to $15 per unit.
Botox can be a great approach to treat some conditions that impact your vision, but you should always discuss treatment options with your optometrist or ophthalmologist.
What Is Botox for Your Eyes?
Botox is famous as an injection, used as a cosmetic procedure to remove wrinkles and smooth skin. These injections come from the botulism toxin. This is produced from the same microbe that triggers botulism, a variety of food poisoning.
Medically produced Botox injections are used to temporarily paralyze muscles. They do not cause the same side effects as consuming the bacteria.
While you may know Botox as a product that makes skin look younger, there are several other uses for injections, including to:
There are some complications to using Botox injections to manage medical conditions that affect your vision, but if you work with an optometrist or ophthalmologist for an appropriate diagnosis and treatment plan, these procedures are safe and effective.
Eye Conditions That Benefit From Botox Treatments
Some conditions that affect your vision can be treated with Botox injections in muscles around the eye. The injections can alleviate discomfort and help the eye focus for clearer vision.
Conditions that benefit from Botox treatments include:
Blepharospasm (eye twitching)
Almost everyone experiences muscle spasms in the eyelids or around the eyes once in a while, but the condition blepharospasm is more painful and complicated than simple twinges. It involves abnormal contraction of the eyelid muscles, causing episodic closure that you cannot control. Blepharospasm occurs in both eyes as opposed to one eye.
Symptoms start as mild, occasional uncontrolled blinking or twitching, but they will progress over time to the point that the person is functionally blind because they are temporarily unable to open their eyes. Periodic injections of Botox help to stabilize the condition. These will wear off over several weeks and symptoms will return, so you will need to get Botox injections every three to four months. These injections require two to three days to become fully effective, and peak effects set in after about one week.
This condition typically sets in early in childhood and is very treatable. Strabismus occurs when the eyes are not aligned properly, pointing in different directions, typically because the nondominant eye has a problem with the muscle that keeps it in place. This can cause the eye to turn inward, outward, or down. It can come and go, or the eye may be consistently misaligned. Because the muscle is weaker in one eye, the brain relies on the dominant eye to process images. The nondominant eye has a decreasing connection to the brain. About 4 percent of children in the United States have this condition. Strabismus treatment focuses on restoring binocular vision by aligning the nondominant eye with the dominant one.
This condition occurs when the upper eyelids begin to droop down over the eyes. Treatment only becomes necessary when eyelids fall so low that it impacts your vision. If eyelids droop far enough that your vision struggles, your ophthalmologist may recommend stimulating the muscles with the back of an electric toothbrush or using eyedrops. If these procedures do not work, you may benefit from periodic Botox injections to tighten the skin, or you may choose to undergo surgery to remove excess eyelid skin.
Ptosis can also be caused by Botox injections around the eyes, especially when performed by an inexperienced injector. Ophthalmologists report that the condition typically wears off in three to four weeks, as the peak effects of Botox under the skin wear off.
Lacrimal gland problems like epiphora, excessive tear production that gets in the way of seeing clearly and spills over onto the face, can be treated with Botox injections. Other symptoms of this condition include:
It is important to work with an optometrist or ophthalmologist to diagnose the underlying condition causing watery eyes and associated symptoms. Most people experience this problem due to an underlying issue like allergies or an infection. If these cause watery eyes, a Botox injection will not help.
If the underlying cause is a tear duct blockage or changes to the structure of the duct, clinical trials have shown that a Botox injection can relax the muscles and close the tear duct, so you do not experience excessive watering.
These headaches have a range of symptoms, including sensitivity to light, flashing or bright flares in your vision, zig-zag lines, or pain in or around the eyes. There may be some symptoms leading up to the migraine, including changes in your vision along with changes in your mood and physical sensations.
If you get migraines more than 15 times per month, your doctor may recommend Botox injections to manage the symptoms. These injections can alleviate all uncomfortable symptoms, including vision changes and light sensitivity, for three to four months.
Effectiveness & Safety of Botox Treatments for Your Eyes
Botox injections can be effective for the eye conditions listed above, but it is a temporary solution. Working with an optometrist or ophthalmologist means you get a diagnosis and treatment plan for underlying conditions that may lead to blepharospasm, watery eyes, or migraines. A treatment plan includes long-term solutions to issues; however, you may find that Botox injections every three to four months are the best solution for you.
Risks and side effects from Botox include:
If you experience these side effects, they should diminish in a few days. Persistent side effects indicate that you should speak with your eye doctor.
Severe side effects can occur in rare instances and require emergency medical attention. These include:
What Does Botox for Your Eyes Cost? Will Insurance Cover It?
Cosmetic use of Botox is not covered by insurance. Out-of-pocket costs for an experienced Botox practitioner will vary. It generally costs about $10 to $15 per unit, with around 20 units on average needed for a typical forehead smoothing treatment. This means the average range of Botox treatment for cosmetic reasons on the skin can be around $200 to $400.
Medical Botox injections are more likely to be covered by insurance. For example, Botox injections in young children with early onset esotropia (a form of strabismus where the eye turns inward) has been found at least as effective as surgery on the eye muscles. It is also much more cost effective, with the average charge for Botox injections being $874 per procedure before insurance compared to $2,783 for the surgery.
Your health or vision insurance will not cover nonmedical or off-label uses of Botox. Speak with your optometrist or ophthalmologist about potential costs and coverage if they recommend this procedure, or if you are interested in pursuing Botox injections to treat a vision problem. You may need preauthorization before you proceed with treatment.
Botox for Your Eyes Is One Treatment Among Several Options
Depending on the underlying vision problem, there may be other options to help your eyesight. Some conditions, like blepharospasm, benefit greatly from Botox treatments. Others, like drooping eyelids or excessively watering eyes, may not benefit as much.
Botox injections are often temporary, requiring a return visit after three to four months. Many people find this to be a cost-effective solution, but if you want a more permanent solution, work with your vision specialist or medical doctor to find other options that are right for you.
If you’re looking to get Botox for Strabismus, the cost of Botox is $500-$1,000 per treatment.
The cost of Botox is based on the number of treatments you need and the area that needs treatment.
Botox injections are safe and effective to treat strabismus. They can be done in just a few minutes. The effects last up to 6 months, but they may last longer depending on your situation.
If you have strabismus, then it is possible that you have developed an involuntary muscle contraction called nystagmus. Nystagmus usually occurs when we focus on one eye and then quickly switch our gaze to another object or person. This causes our eyes to move involuntarily which leads to blurry vision when we look at something close by or far away from us (strabismus).
Botox can help reduce strabismus symptoms by reducing the muscle activity that causes this involuntary movement of your eyes (nystagmus).
How much is botox for strabismus
Botulinum toxin type A has been used to treat numerous types of strabismus in children and adults as both an adjunctive and alternative therapy. A recent report from the American Academy of Ophthalmology found extraocular muscle Botox injection achieved a high success rate of motor alignment comparable with eye muscle surgery for small to moderate angle, nonparalytic, nonrestrictive horizontal strabismus.
Still, the authors cautioned that good alignment may require multiple injections, and the jury is still out on whether sensory outcomes would be the same between Botox and eye muscle surgery in young children.
The findings were based on a literature review of 14 studies consisting of two randomized clinical trials, three nonrandomized comparative studies and nine case series with a minimum of 50 patients who had extraocular muscle Botox injection for initial or repeat treatment of horizontal, nonparalytic, nonrestrictive strabismus with at least six months of follow-up. The comparative studies were graded level II evidence, while the case series were graded as level III evidence.
Successful motor outcomes after Botox injection were relatively consistent across four of the five comparative studies at 60% when adjustment was made for differential selection bias in one of the studies. In these four studies, successful motor outcomes after surgery ranged from 66% to 77% with a follow-up between 23 to 75 months, and the results weren’t significantly different from Botox injection. In the fifth level II study, success was notably higher with Botox injection compared with surgery: 94% vs. 72%, respectively.
Additionally, the level III Botox case series demonstrated higher motor success rates between 87% to 89% when children were treated in two muscles at a time. On the other hand, the rates were lower in adults treated with single-muscle Botox injection.
Both esotropic and exotropic patients were represented in the case series. Although second or third sets of Botox injections were not required in many cases, the cumulative successful motor alignment rate increased when these additional sets of injections were added to the treatment protocol.
One noncomparative case series suggested that very early use of Botox, perhaps even before most surgeons would consider eye muscle surgery, may result in good motor alignment without the need for surgery; however, this hypothesis requires further evaluation, the researchers said.
Despite the findings, a well-designed, randomized control trial is warranted to confirm or refute the equivalency of Botox injection to eye muscle surgery for motor alignment, the authors suggested. Additionally, a prospective study of sensory outcomes is needed, since it’s not clear if faster ocular realignment from eye muscle surgery has a benefit compared with Botox, particularly if two or three sets of injections are required over a six- to nine-month period to obtain good alignment, they added.
how long does botox for strabismus last
Botulinum toxin type A has been used to treat numerous types of strabismus in children and adults as both an adjunctive and alternative therapy. A recent report from the American Academy of Ophthalmology found extraocular muscle Botox injection achieved a high success rate of motor alignment comparable with eye muscle surgery for small to moderate angle, nonparalytic, nonrestrictive horizontal strabismus.
Still, the authors cautioned that good alignment may require multiple injections, and the jury is still out on whether sensory outcomes would be the same between Botox and eye muscle surgery in young children.
The findings were based on a literature review of 14 studies consisting of two randomized clinical trials, three nonrandomized comparative studies and nine case series with a minimum of 50 patients who had extraocular muscle Botox injection for initial or repeat treatment of horizontal, nonparalytic, nonrestrictive strabismus with at least six months of follow-up. The comparative studies were graded level II evidence, while the case series were graded as level III evidence.
Successful motor outcomes after Botox injection were relatively consistent across four of the five comparative studies at 60% when adjustment was made for differential selection bias in one of the studies. In these four studies, successful motor outcomes after surgery ranged from 66% to 77% with a follow-up between 23 to 75 months, and the results weren’t significantly different from Botox injection. In the fifth level II study, success was notably higher with Botox injection compared with surgery: 94% vs. 72%, respectively.
Additionally, the level III Botox case series demonstrated higher motor success rates between 87% to 89% when children were treated in two muscles at a time. On the other hand, the rates were lower in adults treated with single-muscle Botox injection.
Both esotropic and exotropic patients were represented in the case series. Although second or third sets of Botox injections were not required in many cases, the cumulative successful motor alignment rate increased when these additional sets of injections were added to the treatment protocol.
One noncomparative case series suggested that very early use of Botox, perhaps even before most surgeons would consider eye muscle surgery, may result in good motor alignment without the need for surgery; however, this hypothesis requires further evaluation, the researchers said.
Despite the findings, a well-designed, randomized control trial is warranted to confirm or refute the equivalency of Botox injection to eye muscle surgery for motor alignment, the authors suggested. Additionally, a prospective study of sensory outcomes is needed, since it’s not clear if faster ocular realignment from eye muscle surgery has a benefit compared with Botox, particularly if two or three sets of injections are required over a six- to nine-month period to obtain good alignment, they added.
botox for strabismus success rate
Botulinum toxin therapy of strabismus is a medical technique used sometimes in the management of strabismus, in which botulinum toxin is injected into selected extraocular muscles in order to reduce the misalignment of the eyes. The injection of the toxin to treat strabismus, reported upon in 1981, is considered to be the first ever use of botulinum toxin for therapeutic purposes. Today, the injection of botulinum toxin into the muscles that surround the eyes is one of the available options in the management of strabismus. Other options for strabismus management are vision therapy and occlusion therapy, corrective glasses (or contact lenses) and prism glasses, and strabismus surgery.
The effects that are due only to the toxin itself (including the side effects) generally wear off within 3 to 4 months. In contrast, improvements in alignment may be long-lasting, particularly in two circumstances. First, if the “antagonist” muscle (the muscle pulling in the opposite direction) is active, the injected muscle will be stretched, and may permanently lengthen by adding tissue during the period of toxin paresis.[citation needed] Second, if binocular vision has been achieved and stabilized, alignment may “lock in”. There are indications that botulinum toxin therapy is as successful as strabismus surgery for patients with binocular vision and that it is less successful than surgery for those who have no binocular vision.
Botulinum toxin is the most acutely lethal toxin that is known. It is produced by the bacterium clostridium botulinum. It acts inside nerve terminals by decreasing the release of acetylcholine, blocking neuromuscular transmission and thereby causing flaccid muscular paralysis. As a result, the muscle is weakened for about 3 to 4 months.
For treating strabismus, the toxin is used in much diluted form, and the injection is targeted to reach specific muscles that move the eye, thereby temporarily weakening the selected muscles.
After local or general anaesthesia has been applied, the botulinum toxin is injected directly into the selected eye muscles using a specially designed needle electrode that is connected to an electromyography (EMG) apparatus as well as to a syringe containing the botulinum toxin solution.
When under local anaesthesia, the patient is asked to move the eyes just before the toxin is injected. This results in an EMG signal which provides instant feedback on the correct placement of the needle. If the patient is a young child, general anaesthesia is always used.
The duration of the intervention is one to two minutes if the person performing the procedure has sufficient experience.
The dosage to be used cannot be determined with precision, as no reliable relation between dose and effect could be established so far. The toxicity of botulinum toxin varies from one lot to the next; furthermore, the body may show an immunoreaction by which the efficacy of subsequent treatments is reduced.
Botulinum toxin is considered as an alternative to surgery in certain clinical situations. A study performed in the 1980s found outcomes of surgery to be “more predictable and longer lasting” than those of botulinum toxin therapy. As stated in a review article of 2007, its use for strabismus “varies enormously in different cities and countries for no apparent reason.”
In a small-scale study, adults whose reading difficulties due to convergence insufficiency had been unsuccessfully addressed by convergence exercises, base-in prism glasses or strabismus surgery showed improved reading after botulinum toxin therapy, maintaining improved reading remaining also after six months.
Botulinum toxin is considered a useful alternative to surgery in particular cases, for example for persons unfit for general anaesthesia, in evolving or unstable clinical conditions, after unsuccessful surgery, or to provide short-term relief from diplopia.
For patients who have had healthy vision heretofore until a small, horizontal deviation set in suddenly, the injection of botulinum toxin may allow them to maintain the binocular vision skills that had been acquired earlier.
Some consider botulinum injections to be a treatment option for children with small- to moderate-angle infantile esotropia. Studies have provided indications that performing injections into both medial rectus muscles may be more effective than an injection into one medial rectus muscle alone.
Botulinum toxin therapy has been reported to be similarly successful as strabismus surgery for patients with binocular vision and less successful than surgery for those who have no binocular vision. One study found that botulinum toxin therapy had similar long-term success rates for treating infantile esotropia with botulinum toxin A before the age of 12 months as would have been expected from strabismus surgery. Another study reported similar long-term success rates for infantile esotropia treated before 24 months of age by either strabismus surgery or botulinum toxin treatment.
Botulinum toxin has also been used postoperatively for improving the alignment in patients with over- or undercorrection after strabismus surgery, leading to rapid elimination of postoperative diplopia but possibly requiring repeated injections or reoperation later on. It is considered particularly useful for patients who have the potential for binocular vision; success rates are higher for treating postoperative esotropia than for treating postoperative exotropia.
It has also been employed in combination with strabismus surgery in cases in which there is a large horizontal eye deviation and eye muscle surgery on both eyes (binocular surgery) is not an option for other reasons.
The most common side effects are droopy eyelids (ptosis) and over- or undercorrections; a further common side effects are diplopia and inadvertent vertical deviation (hypo- or hypertropia). The side effects typically resolve in 3–4 months.
Vision-threatening complications are rare, and the intervention is generally considered safe, also when performed repeatedly.
It is also under investigation whether the injection of bupivacaine into extraocular muscles is of possible therapeutic use for treating some forms of strabismus, be it alone or in combination with botulinum toxin.
Bupivacaine is a local anaesthetic known to cause considerable myotoxicity and neurotoxicity. Its injection into muscle tissue leads to a dramatic degeneration of muscle fibres accompanied by a moderate inflammatory response. It subsequently leads to a thickening and strengthening of the muscle. The thickening of bupivacaine-injected extraocular muscle has been demonstrated by means of magnetic resonance imaging and by means of ultrasonography.
Bupivacaine injection is therefore being investigated as a further possibility of treating strabismus. In some interventions bupivacaine has been used alone. In others, a botulinum toxin injection into an extraocular muscle is accompanied by a bupivacaine injection into the antagonist muscle.
One noncomparative case series suggested that very early use of Botox, perhaps even before most surgeons would consider eye muscle surgery, may result in good motor alignment without the need for surgery; however, this hypothesis requires further evaluation, the researchers said.
Despite the findings, a well-designed, randomized control trial is warranted to confirm or refute the equivalency of Botox injection to eye muscle surgery for motor alignment, the authors suggested. Additionally, a prospective study of sensory outcomes is needed, since it’s not clear if faster ocular realignment from eye muscle surgery has a benefit compared with Botox, particularly if two or three sets of injections are required over a six- to nine-month period to obtain good alignment, they added.
botox strabismus side effects
Botox injections are a commonly used treatment for strabismus, a condition where the eyes are misaligned and do not point in the same direction. While Botox injections are generally considered safe, there are potential side effects that patients should be aware of.
The most common side effect of Botox injections for strabismus is temporary eyelid drooping or ptosis. This occurs when the Botox spreads to the muscles that control the eyelids, causing them to weaken and droop. In most cases, eyelid drooping is mild and resolves within a few weeks to a few months as the effects of the Botox wear off. Rarely, more severe eyelid drooping may require additional treatment to correct.
Other possible side effects of Botox injections for strabismus include:
- Double vision: In some cases, Botox injections can cause double vision, which can be temporary or permanent. This occurs when the weakened muscles cause the eyes to move in different directions.
- Dry eyes: Botox injections can reduce the production of tears, leading to dry eyes. This can cause discomfort and may require the use of artificial tears or other treatments.
- Headaches: Some patients may experience headaches after Botox injections for strabismus. This is usually a temporary side effect that resolves on its own.
- Allergic reactions: In rare cases, patients may experience an allergic reaction to Botox injections. Symptoms of an allergic reaction can include itching, rash, difficulty breathing, and swelling of the face, tongue, or throat.
It’s important to note that these side effects are rare and generally mild. Most patients tolerate Botox injections for strabismus well and experience few or no side effects. However, it’s important to discuss the potential risks and benefits of Botox injections with your healthcare professional before undergoing treatment.
In summary, while Botox injections are generally considered safe and effective for the treatment of strabismus, there are potential side effects to be aware of. These can include temporary eyelid drooping, double vision, dry eyes, headaches, and allergic reactions. Patients should discuss the potential risks and benefits of Botox injections with their healthcare professional and report any side effects promptly.