‘Eye-opening solution’ available for mild-moderate acquired ptosis
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MONTEREY, Calif. — For someone who is bothered by their low-lying eyelids, Upneeq may be an option, a speaker here told colleagues at the Women in Ophthalmology Summer Symposium.
Upneeq (oxymetazoline hydrochloride ophthalmic solution 0.1%, RVL Pharmaceuticals) is FDA approved for acquired ptosis, offering a nonsurgical, temporary eyelid lift for patients with mild-moderate acquired ptosis.
“It's interesting because the eyes are the central feature of beauty for the face, yet the eyes and the eyelids have been underserved by nonsurgical treatments,” Andrea L. Kossler, MD, FACS, director of oculofacial and orbital surgery at Stanford University, said in a presentation.
Upneeq is an alpha-adrenergic agonist that stimulates Müller’s muscle and contains the same primary ingredient as in decongestant nasal sprays like Afrin and in an older formulation of Visine eye drops, Kossler said.
In two randomized controlled trials of 304 subjects over 6 weeks, researchers at RVL Pharmaceuticals found that the average lift of the eyelid from one Upneeq drop was 1 mm, according to Kossler. Further, the Upneeq drops showed significant visual field improvement compared with the placebo, with it taking effect between 5 minutes and 2 hours and lasting up to 6 to 8 hours.
In terms of when to use it, Kossler said it is a temporary solution for individuals who are not candidates for surgery or do not want surgery.
“Sometimes we wear fake eyelashes, sometimes we wear extensions in our hair, sometimes people wear colored contact lenses,” Kossler said. “Would you potentially want a temporary solution, maybe look different? ... Have some eyes that pop?”
Individuals who undergo ocular surgery, have botulinum toxin-induced ptosis or thyroid eye disease, and are waiting for a surgical evaluation could also use Upneeq, Kossler said.
Safety of Upneeq was evaluated through an additional 12-week study that included 157 subjects. Kossler said 5% of patients experienced punctate keratitis, conjunctival hyperemia, dry eye symptoms, blurry vision, mild discomfort, irritation and headache, but these were reported as mild and temporary.
Although Kossler said it may interfere with medications, including beta-blockers, antihypertensives and monoamine oxidase inhibitors, Upneeq did not significantly change blood pressure, heart rate or pupil size in the study.
“In the Visine studies with prolonged use at a higher concentration, we did see rebound hyperemia, so it's certainly something that I talk to my patients about,” Kossler said. “However, I'm not really recommending this to people that need a permanent solution or that want to use the drug every single day. It's more for my patients that just want an option for when they're going out on the weekend and maybe use it a few times a week.”
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The noninvasive eyelid lift: An alternative aesthetic option. Presented at: Women in Ophthalmology Summer Symposium; Aug. 25-28, 2022; Monterey, California (hybrid meeting).
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