Non-allergic Eyelid Edema post Botulinum Toxin Type A Injection: The Mechanism, Clinical Course, Treatment Strategy, and Prevention

Purpose:

Post-Botulinum Toxin type A (BoNTA) injection perioccular adverse events is less common but can bother the patient mostly due to eye disfiguration and vision block. Among them, eyelid ptosis is a well-known lavator muscle–related adverse effect, while eyelid edema is still rarely reported with comprehensive consensus on the presence, clinical course and treatment.

Materials and Methods:

The literature review was conducted by PubMed to identify clinical publication on adverse effects of eyelid edema after botulinum toxin injection near glabellar line and crow’s feet. We also performed a retrospective institutional review for all patients who have received botulinum neurotoxin type A (BoNTA) in our hospital.

Results:

The global literature review enrolled in five articles. The total eyelid edema incidence after BoNTA injection was 0.49% (41/8,349). There was no description for the complete history, severity, and further management of post BoNTA injection eyelid edema. The incidence was quite rare but tended to see in Asian population, with the median onset time of 5 (2-106) days and the median duration of 15 (7-85) days. The incidence of eyelid edema after BoNTA injection near glabellar line and crow’s feet was 2.24% (12/536) in Asian group, and we reported 0.8% (1/126).

Conclusion:

Patients who have the risk factors including Asian ethnicity, dermatochalasis, poor periocular muscle tone should be warned about periorbital edema which will self-resolve in 2 to 4 weeks once it happens. The strategy for preventing eyelid edema is performing winking test first to examine the function and muscle tone of blinking muscle. Half of the dose is suggested for the patients at risk. The advised applications include hot pads over the eyes, frequent blinking in the morning and self-massage of the affected area in order to increase venous return.