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

Treatment Protocol for Acquired Blepharoptosis Using Upneeq (Oxymetazoline Hydrochloride)

The recommended treatment protocol for acquired blepharoptosis is one drop of Upneeq (oxymetazoline hydrochloride 0.1%) ophthalmic solution in the affected eye(s) once daily. This medication provides rapid and sustained upper eyelid elevation with significant improvements observed as quickly as 5 minutes after administration 1, 2.

Dosing and Administration

• Frequency: Once daily application
• Amount: One drop per affected eye
• Duration: Continuous daily use is supported for at least 42 days based on clinical trials 1, 2
• Administration technique: Patient should self-administer by placing one drop in each affected eye

Efficacy Timeline

• Onset: Rapid onset of action with measurable eyelid elevation within 5-15 minutes after instillation 2
• Peak effect: Significant improvement in marginal reflex distance 1 (MRD-1) observed at 2 hours post-instillation 1
• Duration of daily effect: Clinical studies demonstrate sustained effect for at least 6 hours after instillation 1, 2

Monitoring and Assessment

1. Baseline assessment:

   • Document pre-treatment marginal reflex distance 1 (MRD-1)
   • Assess superior visual field using Leicester Peripheral Field Test or similar method
   • Photograph patient's appearance for comparison

2. Follow-up evaluations:

   • Initial follow-up at day 14 to assess response
   • Subsequent follow-up at day 42 to evaluate sustained effect
   • Measure changes in MRD-1 and superior visual field at each visit

Expected Outcomes

• Mean increase in MRD-1 of approximately 1 mm (0.96 mm on day 1.16 mm on day 14) 1
• Significant improvement in superior visual field with increased number of points seen on visual field testing 1
• Positive response (>0% MRD-1 increase) in significantly more patients compared to placebo 2

Patient Selection Considerations

• Appropriate for adults with acquired blepharoptosis
• Particularly beneficial for patients who:
  • Are not surgical candidates
  • Prefer non-surgical intervention
  • Need temporary management before definitive surgical correction
  • Have mild to moderate ptosis

Contraindications and Precautions

• Caution in patients with:
  • Severe cardiovascular disease (due to alpha-adrenergic properties)
  • Narrow-angle glaucoma
  • Concurrent use of monoamine oxidase inhibitors
  • Hypersensitivity to oxymetazoline or any component of the formulation

Potential Side Effects

• Most treatment-emergent adverse events are mild in intensity 1
• Common side effects include:
  • Punctate keratitis
  • Conjunctival hyperemia
  • Dry eye
  • Blurred vision
  • Headache
  • Instillation site pain

Special Considerations

1. Concurrent conditions:

   • In patients with concurrent blepharoptosis and blepharospasm, Upneeq may have synergistic effects when used with botulinum toxin 3
   • For patients with concurrent dry eye disease, consider appropriate management of the ocular surface 4

2. Preoperative assessment:

   • If considering surgical correction in the future, document response to Upneeq as this may inform surgical planning 4
   • Blepharoptosis can induce corneal astigmatism or make astigmatism more difficult to measure 4

Practical Recommendations

• Instruct patients to apply the medication at a consistent time each day
• Advise patients that the effect is temporary and requires daily application for continued benefit
• Consider photographic documentation at baseline and follow-up visits to demonstrate effect
• For patients with severe ptosis (>3 mm), Upneeq may provide significant improvement but may not completely resolve the condition 5

Upneeq represents an important non-surgical option for acquired blepharoptosis management, with clinical trials demonstrating both functional and cosmetic improvements in affected patients 1, 2.