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Botulinum toxin injection causing lateral rectus palsy
  1. Celia S Chen1,
  2. Neil R Miller2
  1. 1Neuro-Ophthalmology Unit, Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to: Dr N R Miller Maumenee 127, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA;nrmiller{at}

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A 35-year-old woman with brow spasms, treated in the past with Botox, was referred for increasing tightness in the brow. She reported having experienced an episode of difficulty focusing after a previous injection of Botox by another physician. The patient had no response to a subcutaneous injection consisting of 10 units of Botox above the eyebrows, nor to a subsequent injection of 20 units in the same location 2 months later. A third injection of 35 units of Botox resulted in improvement of her brow spasms, but only for 48 h. Accordingly, 2 months after the third injection, she was injected with 75 units of Botox, with 30 units injected in three separate locations above each eyebrow and 7.5 units injected …

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  • Competing interests: None.

    Informed patient consent was obtained for the publication of the persons details in this report.