Difficulties with BoNT use in ophthalmology come up on account of toxin diffusion or inadvertent placement to the adjacent muscles. Ptosis from the eyelid is the most common complication of BoNT treatment of strabismus and blepharospasms.23 Although this effect is almost always non permanent and self-resolving, apraclonidine 0.5% (Iopidine) or phen