No retinal detachment or visual loss occurred in any case. Sixteen retrobulbar hemorrhages occurred. Decompression of the orbit after five minutes was done to restore retinal circulation in one case. No eye lost vision from retrobulbar hemorrhage. This can be prevented by applying pressure at the injection site immediately after the injection.
Perforation requiring corneal grafting occurred in one case, anaphakic eye.
Avoidance of injection into the lower lid area to avoid ectropion may reduce this hazard. Vigorous treatment of any corneal epithelial defect should be employed. This may require protective drops, ointment, therapeutic soft contact lenses, or closure of the eye by patching or other means. The effect of botulinum toxin may be potentiated by aminoglycoside antibiotics or any other drugs that interfere with neuromuscular transmission.