Ptosis and diplopia after incidental botulinum powder exposure

Purpose To report the occurrence of an unilateral ptosis and diplopia not direct injection of botulinum but incidental botulinum power exposure. Methods This is a case report of botulinum powder's local effect. Results Thirty years old woman visited our hospital due to ptosis and diplopia. She did botulinum powder purification at her laboratory and incidentally botulinum power was spattered to her right eye. Two days later, right lid ptosis was developed and the next day, diplopia was occurred. She also showed right eye pupil dilatation and hypotropia. She was taken brain MRI and we couldn't find pathologic lesion. One month later, the diplopia was disappeared and ptosis was much improved. Conclusions In addition to direct periocular injection, only botulinum power exposure can also make local effect, such as ptosis, muscle paresis, pupil dilatation.