Issues with BoNT use in ophthalmology come up as a result of toxin diffusion or inadvertent placement in the adjacent muscles. Ptosis with the eyelid is the most common complication of BoNT treatment of strabismus and blepharospasms.23 Although this outcome is nearly always short term and self-resolving, apraclonidine 0.5% (Iopidine) or phenylepher