Botulinum treatment for entropion

This page is for patients considering botulinum toxin injections for in-turning lower eyelid (entropion).

What is the effect of botulinum toxin?

Botulinum toxin causes a temporary, partial or complete, paralysis (weakness) of the muscle into which it has been injected. It can beused to turn out an in-turning lower lid by injecting it into the muscles of the lower lid.

Will botulinum toxin affect my general health?

The treatment is safe and there is no risk of developing botulism or food poisoning. Wehave never had a patient who has experienced any general health problem with botulinum,but all medication carries a small potential risk of a serious allergic reaction (anaphylaxis).

There is no known risk when the treatment is given to women who are pregnant or breastfeeding, but some patients prefer to postpone treatment until they have given birth or weaned their child. If you are breastfeeding, we strongly advise that you express your milk to use for 24-48 hours following the injection. 

For further information on the use of botulinum toxin in breastfeeding & pregnancy.

What should I expect when I attend the clinic?

You will be seen by a nurse or healthcare assistant followed by a doctor working with the consultant ophthalmologist. If the treatment is suitable for you, you will be asked to read and sign a consent form and will usually receive the treatment on the same day. You should expect to be in the clinic for the whole morning or afternoon.

What is the treatment procedure?

You will be given local anaesthetic drops to numb your eye, but you might still experience some discomfort when the injection is given. Three small injections are given into the lower lid, just below the lid edge.

What happens after the injection?

You will be able to go home after the injection. You may feel an ache in the injected area for which you can take a painkiller as needed.

When should I expect to see results from the treatment?

Results are usually noticed about two days after the injection is given.

How long do results last?

This can vary, but results can last up to four months.

What are the possible side effects?

With any injection in or around the eye it is possible to suffer a serious side effect affecting the eye or vision but this is extremely rare.

Nearly all side effects are temporary and recover with time. Potential side effects are as follows:

  • Out turning of the lower lid (ectropion).
  • Drooping of the lower lid, cheek or mouth.
  • Temporary double vision – you should not drive while you have double vision. It is very important that you discuss this with the doctor before treatment if this is of particular concern to you (see DVLA website: double vision and driving).
  • Slight bruising of the eyelid.

When do I return to the clinic?

We will make an appointment for you to return to the clinic three to four months after your treatment.

Other important information

Botulinum toxin has been used for treating eye conditionsat Moorfields since 1982 and for entropion since 1988. Although Botulinum toxin was originally introduced for the treatment of squint in 1979 (with our clinics successfully treating patients since 1982), the manufacturers have never applied for a drug productlicence. We use it on a “named patient” basis, and records are kept of all injections and patient details. This is one of many examples of a drug with a product licence for one condition being used safely and successfully for another condition.

If you have any reason to believe that you may be a carrier of hepatitis or the HIV virus,please make sure that you tell the nurse or doctor who sees you in the clinic. Theinformation is kept confidential, but it is essential that we are informed.

If you are not clear about any part of this treatment or have any questions, please ask the doctor to explain further.


Authors: Daniel Ezra, consultant, adnexal service and Anna Ginter, adnexal fellow

Review date: April 2020