Effect of Topical Botulinum Toxin Eyedrop on Palpebral Fissure

Inclusion Criteria: Adults aged 18 and above that present to the oculoplastic and reconstructive surgery department that are able to provide informed consent to participate Presence of upper eyelid retraction or asymmetry( >1mm) Exclusion Criteria: Adults unable to consent Individuals less than 18 years of age Prisoners Pregnant women. o Patients will be asked if they are pregnant by research staff before participation in the study. Women who are breast-feeding Known contradictions or sensitivities to study medication Grossly abnormal lid margins, anatomical abnormalities Variable ptosis or eyelid position (e.g., myasthenia gravis, blepharospasm) Any ocular or systemic condition that, in the opinion of the investigator, would confound study data, interfere with the subject's study participation, or affected the subject's safety or trial parameters Presence of an active ocular infection Inability to sit comfortably for 15 - 30 minutes Botulinum toxin injection in the eyelids during the past 3 weeks. Neuromuscular disorders (e.g., Parkinson's disease or myasthenia gravis) Medication use known to interfere with the effects of botulinum toxin-A within the previous 1 month (e.g., aminoglycoside or benzodiazepines), Previous history of hypersensitivity reactions to botulinum toxin-A Dysfunction of tear production or secretion (e.g., meibomian gland dysfunction or Sjogren's syndrome),