Purpose

To present a case of acute ptosis after abobotulinumtoxinA (Dysport) injection in which minor forehead trauma likely unmasked clinically evident dysfunction, and to emphasize conservative management and the potential adjunctive role of PRP.

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Methods

Single-case report. Ophthalmic and neuro-ophthalmic evaluation, cranial nerve exam, cranial CT, and laboratory tests were normal. Neurogenic and structural causes were excluded. Serial MRD1 and levator function were recorded.

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Results

A 30-year-old female developed acute right ptosis 10 days after abobotulinumtoxinA (Dysport) injection and 4 days after minor forehead trauma. Visual acuity, intraocular pressure, and anterior–posterior segments were normal. Cranial nerve exam was normal. Pupils were equal with intact light reflexes and no RAPD.

Right periorbital edema and ecchymosis were present. Marked ptosis with pupil coverage and loss of lid crease was observed. Levator function was 3 mm (right) vs. 17 mm (left). Phenylephrine test was negative.

Ocular motility was full. Binocular diplopia occurred in right gaze and upgaze, resolving with occlusion. CT and laboratory investigations were normal.

Toxin-related levator dysfunction was favored. Conservative management (warm compresses, topical phenylephrine and brimonidine twice daily) was initiated. Three PRP sessions were applied. MRD1 improved stepwise (−4 → −3 → −1 → +3 mm) with complete resolution of diplopia.

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Conclusion

Botulinum toxin–induced ptosis is a transient condition caused by diffusion to the levator muscle. AbobotulinumtoxinA (Dysport) may exhibit a relatively wider diffusion profile, which can increase unintended spread. Minor trauma may further increase local permeability, facilitating toxin diffusion and unmasking subclinical effects.

Accurate assessment, supported by normal neurological, imaging, and laboratory findings, allowed exclusion of neurogenic causes and avoidance of unnecessary surgery. PRP was associated with relatively rapid recovery and may support neuromuscular healing, although spontaneous resolution is expected.

Recognizing toxin-related ptosis and prioritizing conservative management can prevent unnecessary surgery; diffusion characteristics and trauma may contribute; PRP may support earlier recovery.

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Additional Authors

First name	Last name	Base Hospital / Institution
Hikmet Miray	Yıldızdoğan	University of Health Sciences, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital , İstanbul, Türkiye
Muhammed Fatih	Satılmaz	University of Health Sciences, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital , İstanbul, Türkiye
İdil	Gülol	University of Health Sciences, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital , İstanbul, Türkiye

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