Iatrogenic Ptosis Mimicking Cranial Nerve III Palsy Following Cosmetic Botox Injection: A Case Report

Authors

• Moath Alshanqity, Assistant Consultant, Emergency Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi ArabiaFollow
• Lujain Filimban, Emergency Medicine Resident, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
• Sadaqah Wazzan, Emergency Medicine Resident, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia

Keywords

Cranial nerve palsy; botulinum toxin; oculomotor nerve; cosmetic injection; iatrogenic botulism; medical error; patient safety

Document Type

Case Report

Abstract

We present a 40-year-old female who developed iatrogenic ptosis mimicking cranial nerve III palsy after undergoing a cosmetic treatment to treat periorbital hyperpigmentation. Within 48 hours of receiving what was believed to be tranexamic acid (TXA) injections, the patient developed isolated left ptosis and generalized headache. Stroke, cerebral venous thrombosis (CVT), subarachnoid hemorrhage (SAH), and cranial nerve injury were among the differential diagnoses upon presentation. No insult to the central nervous system was found during the initial workup, which included neuroimaging. Although TXA was initially suspected due to its prothrombotic potential and the patient’s history of pulmonary embolism, it has no known neurotoxic effects, and the pattern of findings did not support a thrombotic or central etiology. Botulinum toxicity (BoNT) was not initially suspected. It was discovered that a BoNT injection was mistakenly given into the patient's upper eyelid without her consent, according to a follow-up with the patient and her dermatological clinic. This case highlights the significance of patient safety procedures, follow-up correspondence, and a comprehensive history in aesthetic practice.

Publisher

Saudi Toxicology Society

Recommended Citation

Alshanqity, Moath; Filimban, Lujain; and Wazzan, Sadaqah (2026) "Iatrogenic Ptosis Mimicking Cranial Nerve III Palsy Following Cosmetic Botox Injection: A Case Report," Saudi Toxicology Journal: Vol. 3: Iss. 1, Article 1.
DOI: https://doi.org/10.70957/uqu.edu.sa/s.toxicology.s/stj.2025.1.3.5
Available at: https://stj.researchcommons.org/journal/vol3/iss1/1

DOI

https://doi.org/10.70957/uqu.edu.sa/s.toxicology.s/stj.2025.1.3.5

December 2025