What is the treatment for acquired blepharoptosis using Upneeq (oxymetazoline hydrochloride)?

Treatment of Acquired Blepharoptosis Using Upneeq (Oxymetazoline Hydrochloride)

Upneeq (oxymetazoline hydrochloride 0.1% ophthalmic solution) is the recommended first-line pharmacologic treatment for acquired blepharoptosis, providing rapid and sustained eyelid elevation with once-daily administration. 1, 2

Mechanism and Efficacy

Upneeq works through the following mechanisms:

• Stimulates alpha-adrenergic receptors in Müller's muscle
• Causes contraction of the muscle, resulting in upper eyelid elevation
• Provides measurable improvement in both:
  • Eyelid position (measured by marginal reflex distance 1 or MRD-1)
  • Superior visual field (measured by Leicester Peripheral Field Test)

Clinical evidence demonstrates:

• Rapid onset of action within 5-15 minutes after administration 2
• Peak effect at 2 hours post-administration
• Duration of effect up to 6 hours
• Sustained efficacy with continued daily use over 42 days 2

Administration Protocol

1. Dosage: One drop in the affected eye(s) once daily
2. Application:
   • Wash hands before administration
   • Pull down lower eyelid to create a pocket
   • Place one drop in the pocket
   • Close eyes gently for 1-2 minutes to allow absorption
   • Avoid touching the dropper tip to any surface
3. Timing: Morning administration is recommended for maximum daytime benefit
4. Duration: Continuous daily use is required for sustained effect

Clinical Response Expectations

• Immediate response:

  • Mean increase in MRD-1 of 0.59 mm at 5 minutes and 0.93 mm at 15 minutes after first dose 2
  • Visible eyelid elevation typically noticeable within 15 minutes

• Sustained response:

  • Mean increase in MRD-1 of 1.16 mm after 14 days of treatment 1
  • Significant improvement in superior visual field (mean increase of 7.1 points on Leicester Peripheral Field Test at day 14) 1

Patient Selection

Upneeq is most appropriate for:

• Adults with acquired blepharoptosis (not congenital)
• Patients with mild to moderate ptosis
• Those seeking non-surgical treatment options
• Patients with visual field deficits caused by drooping eyelids

Monitoring and Follow-up

• Assess response at 2 weeks after initiation
• Evaluate both subjective improvement and objective measures:
  • Change in MRD-1
  • Improvement in superior visual field
  • Patient-reported visual function and cosmetic satisfaction

Safety Considerations

• Common side effects:

  • Punctate keratitis
  • Conjunctival hyperemia
  • Dry eye
  • Blurred vision
  • Irritation and pain at instillation site

• Precautions:

  • Use with caution in patients with cardiovascular disease
  • Monitor for potential systemic alpha-adrenergic effects
  • Avoid in patients with narrow-angle glaucoma
  • Not recommended for use with contact lenses

Special Considerations

• Synergistic effects: Some evidence suggests Upneeq may enhance the effects of botulinum toxin in patients with concurrent blepharospasm 3
• Limitations: Effects are temporary and require continued daily use
• Alternative options: Surgical correction remains the definitive treatment for permanent correction of ptosis

Upneeq represents a significant advancement as the first FDA-approved pharmacologic treatment for acquired blepharoptosis, offering a non-surgical option for patients who may not be candidates for or prefer to avoid surgery.