To report a case of temporary accommodation difficulties after botulinum toxin injections for the treatment of palmar and plantar hyperhidrosis.

A 27-year-old woman presented with difficulties performing near work that had begun 1 week prior. She underwent injections of botulinum toxin type B (Myobloc®) for the treatment of both palmar and plantar hyperhidrosis 3 weeks earlier. The patient had subdermal injections of 3000 MU (mouse unit) of Myobloc® on each palm and sole. On manifest refraction, the patient was emmetropic. Near point of accommodation was 32 cm in the right eye and 25 cm in the left eye, near point of convergence was 10 cm, and the monocular accommodative power measured with minus lenses was 1.5 diopter (D) in the right eye and 2.0 D in the left eye. After 3 weeks, accommodation difficulties were completely resolved and hyperhidrosis symptoms did not recur.

Ophthalmologic adverse effects related to the autonomic nervous system such as accommodation difficulties may occur with injections of botulinum toxin type B for the treatment of hyperhidrosis. These symptoms should be explained carefully to the patient before the botulinum toxin injection procedure.