When most people think of Botox, they think about cosmetic injections, but this popular medical treatment is used to treat several more serious conditions. (Learn More)

Ophthalmologists use Botox injections around or under the eyes to treat various conditions that impact vision. These include lazy eye, eyelid twitching, migraines, drooping eyelids, and excessive tearing or dry eyes. (Learn More)

There are some risks and side effects with Botox that are important to understand. For the most part, Botox injections are safe solutions to symptoms of certain medical conditions. (Learn More

botox procedure

Is Botox Used for More Than Just Cosmetic Reasons?

When you mention Botox to the average American adult, they will probably first assume you are talking about a type of cosmetic procedure, which temporarily paralyzes muscles to remove wrinkles. Botox was the top cosmetic surgery procedure in 2017, with more than 1.5 million treatments. However, Botox is applied to several medical conditions, including as a treatment for excessive sweating (hyperhidrosis), chronic migraines, and neck spasms.

An injection of Botox temporarily prevents muscles from moving and block certain chemical signals from nerve endings. This can relax the skin around the area and relieve pain or discomfort from spasms.

The treatment comes from the botulism toxin, which causes food poisoning. However, Botox treatments are highly regulated and very safe.

Each injection takes about 10 minutes, and treatments are often outpatient procedures so you will have no downtime afterward. The injections can hurt, but there should be no lingering effects within a day or two afterward.

Botox injections can also help with a range of eye conditions — not just “crow’s feet” or other wrinkles around the eyes, but also with medical issues that can change how people see the world.

Vision Procedures Around the Eye Using Botox

Each eye has six mus...

Each eye has six muscles, two of which move the eyeball itself from side to side. When these muscles work against each other, it helps to keep the eye straight, but when one muscle grows weak, the other pulls the eye to the side.

While many people may have some Botox injections in middle age or later to reduce the number of wrinkles around their eyes, eyebrows, and forehead, using Botox injections in, around, and under the eye can treat specific medical conditions. These conditions include:

  • Strabismus (lazy eye): This condition is essentially an imbalance in strength in the muscles that keep the eyes focused and moving together. Strabismus can also be caused by nerve damage around the eyeball or leading from the eye to the brain, so visual signals from one eye are not interpreted as well as from the other eye.Strabismus is more common in children, and it usually involves placing an eye patch over the dominant eye, so the less muscle-toned eye can gain strength, both in muscle coordination and the optic nerve’s signals to the brain. Eye glasses and surgery can also help to correct lazy eye, but they are not needed as often as simple early childhood training.Symptoms of strabismus, if it is not obvious, include:
    • Impaired vision, particularly in one eye more than the other.
    • Double vision.
    • Lower depth perception.
    • Eye strain.

Adults with strabismus that begins suddenly may have an underlying condition that requires medical treatment. Lazy eye by itself, though, is very treatable

Botox injections are typically one of the last approaches to managing the condition. Eye exercises along with corrective lenses via glasses or contacts are the main approach to treatment.

  • Blepharospasm (eye twitching): Sometimes, muscles around the eye near the eyelid can twitch involuntarily. This is called myokymia, and it can involve the lower lid, upper lid, or both.For most people, these twitches are mild, and they feel like a quick tug. Most people experience them once in a while; however, for some, they become chronic and can impact vision by forcing both eyelids closed completely. These episodes may occur on and off for several days and then go away for months. Their unpredictability can make them disruptive. When this becomes excessive, Botox injections can relieve that twitching.In rare cases, blepharospasm can be an early symptom of a chronic movement disorder, especially when facial spasms become larger and are accompanied by other movements. Stress, exhaustion, eye or eyelid strain, eye irritation, medication side effects, or recreational substances like tobacco and alcohol can all contribute to this condition’s severity.Additionally, blepharospasm may be made worse by:
    • Blepharitis (inflammation of the eyelid).
    • Conjunctivitis (pink eye).
    • Dry eyes.
    • Light sensitivity.

blepharitis progression

If blepharospasm is coupled with redness, swelling, discharge, upper eyelid drooping, several weeks of twitching almost nonstop, full closing of both eyes that you cannot control, and twitching spreading to other parts of your face, it is time to see a doctor.

There are several approaches to treatment, including lifestyle changes, better sleep, over-the-counter eye drops, and warm eye compresses. If the twitching continues while the main cause of blepharospasm is being treated, you may also get Botox injections.

  • Migraine: People who struggle with chronic migraine headaches report having trouble with light sensitivity, seeing flashes of light, or eye pain. If you experience migraine headaches for 15 days or more per month, Botox can help to alleviate those symptoms.
  • Drooping eyelid: In extreme cases, drooping in the eyelids from slack muscles or tendons can reduce one’s field of vision.
  • Eye dryness or excessive tearing: If there are blocks or excesses in the lacrimal flow, or watering of the eyes through the tear ducts, then Botox injections can help to manage this condition. The treatment can widen the area so blockages can move out or tears can move around them. Too much tearing and a Botox injection can help to tone the tear ducts, so they do not water so much.

Minimal Risks and Side Effects From Botox Around the Eyes

Botox has been used to treat lazy eye since the 1980s, and it has been applied to a wider range of treatments in the past several decades. While Botox treatments are largely safe, there are still some caveats to keep in mind.

First, Botox injections can be life-changing, but for chronic conditions, they are not a permanent solution. It is important to get medical treatment for anything that may cause eye twitching, lazy eye, migraines, or other problems in or around the eye itself. Botox treatments typically alleviate symptoms, but they do not permanently fix the discomfort. You will likely need to go back to your doctor every few months for another injection.

Next, if you have any medications, your dose may need to be adjusted to reduce or prevent a reaction with the Botox injection. If you have ever had facial or eye surgery, this could produce side effects with Botox, so let your doctor know.

Finally, it is possible to have an allergic reaction to Botox injections, so if you have any severe symptoms, call 911 or otherwise get emergency medical treatment. Serious symptoms include the following:

  • Shortness of breath
  • Trouble swallowing
  • Vision problems
  • Trouble holding up your head
  • Difficulty moving your face a few days or weeks after the procedure
  • Rash or hives
  • Chest pain
  • Irregular heartbeat
  • Fainting
  • Seizures

There may be some side effects after treatment, including pain or swelling at the injection site, numbness, muscle spasms or twitching, but these will go away within hours or a few days.

Many people get regular Botox injections, including around the eyes, to maintain a youthful appearance, as one application will not manage everything.

Usually a few days after getting Botox, the muscles around the injection site start to freeze up, including the smaller muscles around your eyes and on your upper and lower eyelids. Full results of the procedure set in after about one week.

At this point, you are likely to be happy with your appearance. However, as Botox begins to wear off, you may become concerned that the skin around your eyes is becoming wrinkly again. This is normal.

How Long Does Botox Around the Eyes Last?

For most people, Botox injections last between three and four months. Then, the effects will gradually start to wear off.

A medical study examining the effects of Botox specifically for crow’s feet around the eyes found that the median time the treatments lasted was between 119 and 121 days, which is about four months total. This timeline may be slightly different for you, depending on:

  • Your overall health.
  • Your age.
  • How much time you spend outdoors, especially without sunscreen.
  • Genetic or family history.
  • Your body’s reaction to Botox.

Although Botox has been approved for use in some parts of the face, it is important to know that the United States Food and Drug Administration (FDA) has not approved the treatment for lines or bags underneath the eyes. However, many cosmetic surgery and treatment providers will offer Botox in this area. Medical studies, like the one above, show that the treatment can make the lower eyelid area appear plumper or fuller, which reduces the appearance of wrinkles, lines, and dark circles for many people.

Side effects from Botox under or around the eyes should wear off as the muscle paralysis goes away. If you continue to experience side effects from Botox in this area, get in contact with your doctor immediately for help. Botox side effects should not last more than a few days after the injection, even if you have had the maximum 8 units of Botox to manage the appearance of the skin around your eyes.

You can help Botox treatments last longer by avoiding direct sunlight as much as possible. Wear sunscreen for outdoor activities like swimming, running, and cycling. You should also wear sunglasses that provide protection against ultraviolet (UV) light, specifically sunglasses rated for UVA and UVB protection. If you cannot find these at a local retailer, you can ask your optometrist for recommendations.

Take care of the skin around your eyes with high-quality skincare products, and keep stress levels low. Not only will this help the Botox around your eyes to last as long as possible, but it will ensure healthier skin all over your body.

References

Botox Injections. All About Vision.

Botox Injections. (February 13, 2019). Mayo Clinic.

What Causes Crossed Eyes? (November 4, 2016). Healthline.

Eyelid Twitch. (August 6, 2018). Healthline.

Botulinum Toxin Injection for the Treatment of Epiphora in Lacrimal Outflow Obstruction. (March 6, 2015). Eye: The Scientific Journal of the Royal College of Ophthalmology.

Botox: Good for the Eyes, Not Just for Wrinkles. (January 20, 2009). Everyday Health.

Forehead Botox: The Cost, Benefits, and Everything Else to Know. (July 2019). Harper’s Bazaar.

Duration of Clinical Efficacy of OnabotulinumtoxinA in Crow's Feet Lines: Results From Two Multicenter, Randomized, Controlled Trials. (May 2016). Dermatologic Surgery.

Can You Use Botox Under Your Eyes? (May 2018). Medical News Today.

How to Make Your Botox Last Longer, According to Dermatologists. (May 2020). Well + Good.