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Difficulties with BoNT use in ophthalmology arise due to toxin diffusion or inadvertent placement into the adjacent muscles. Ptosis with the eyelid is the most common complication of BoNT treatment of strabismus and blepharospasms.23 Whilst this effect is almost always momentary and self-resolving, apraclonidine 0.5% (Iopidine) or phenylepherine hy