Issues with BoNT use in ophthalmology arise because of toxin diffusion or inadvertent placement in to the adjacent muscles. Ptosis in the eyelid is the commonest complication of BoNT treatment of strabismus and blepharospasms.23 Whilst this impact is nearly always non permanent and self-resolving, apraclonidine 0.5% (Iopidine) or phenylepherine hyd