Can Botox® Cause Blindness?

Author

Dr. Stephen Cosentino

Botox® injection is the world’s most popular minimally invasive cosmetic procedure. Its benefits — and risks — affect millions of patients each year.

While generally regarded as safe, Botox does have well-known side effects. Depending on where it’s injected on the face or neck, these can include droopy eyelid (ptosis), crooked smile, and temporary paralysis of specific muscles.

One potentially serious cosmetic injection side effect that has gotten more attention lately is blindness. Maybe you’ve even heard rumors of patients losing their vision after Botox injections. These claims are serious and shouldn’t be taken lightly, but it’s also important to sort fact from fiction (and misinformation).

Can Botox Cause Blindness?

There are no documented claims of Botox causing blindness. A comprehensive meta-review of post-injection blindness reports — at least 50 worldwide over the past 20 years — did not implicate Botox in any incidents.

This doesn’t entirely rule out the possibility that Botox could cause blindness in certain circumstances, but blindness following any type of facial injection is extremely rare, and it appears even less common following botulinum toxin injection. As long as the injector avoids areas around the eye that aren’t suitable for Botox injection anyway, the risk is vanishingly low.

Can Other Cosmetic Injections Cause Blindness?

According to the meta-study and anecdotal evidence from patients and providers, other types of cosmetic injections are more likely to cause blindness, even if their risk is also extremely low.

Specifically, dermal filler injections have been implicated in several dozen cases of blindness. Hyaluronic acid is the most common type of dermal filler and is thus implicated in a number of instances, but so have calcium hydroxylapatite (CaHa) and poly-L-lactic acid (PLLA) fillers.

The mechanism appears to be blood clots caused by filler injection into blood vessels. When clots form in the blood vessels that supply the eye and ocular nerves with oxygen and nutrients, cell death may result. And because nerve cells regenerate slowly or not at all in adults, post-procedure blindness or vision impairment may be permanent.

Botox may be less likely to cause blindness because it doesn’t form clots as readily when injected into blood vessels. However, injecting Botox into blood vessels can cause other problems, some potentially serious.

Other Possible Vision Side Effects of Botox

Botox might not cause blindness, but it’s not totally risk-free. Certain Botox side effects and complications can temporarily affect vision:

Localized allergic reaction (generally caused by an additive in Botox, not the toxin itself) can cause swelling or itching that interferes with vision
Ptosis (eyelid droop) can impede the field of vision
When injected near the eye itself, Botox can cause corneal irritation, similar to severe hay fever

The good news is that these side effects are temporary, lasting only as long as the Botox itself (generally three to six months).

The best way to avoid any of these vision-related side effects is to choose an experienced, licensed, board-certified provider who has completed an accredited botulinum toxin training course. Even if Botox hasn’t been implicated in any cases of blindness to date, there’s no reason not to do everything possible to minimize its other risks.