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),