Eyelid and aesthetics · Rx drop
Upneeq for Acquired Ptosis a once-daily drop for low-lying lids.
Upneeq (oxymetazoline hydrochloride ophthalmic solution) 0.1% is a prescription drop indicated for acquired blepharoptosis in adults. It gives eye care practices a non-surgical option for patients with mild lid droop, alongside the exam that rules out serious causes first.
Quick answer
Rule out the serious causes, then consider the drop.
Upneeq is an alpha adrenoceptor agonist that targets Müller's muscle in the upper eyelid. One drop in each affected eye once daily lifted the lid in two randomized trials. The label warns that ptosis can signal neurologic or orbital disease, so a careful exam comes before any prescription.
Key takeaways
- Indicated for acquired blepharoptosis in adults.
- One drop into one or both ptotic eyes once daily, from a single patient-use container.
- Remove contact lenses before use and wait 15 minutes to reinsert.
- Most common adverse reactions (1 to 5 percent) include punctate keratitis, hyperemia, dry eye and blurred vision.
- Use caution with cardiovascular disease and in patients at risk of angle closure.
What the label and trials say.
From the FDA prescribing information and the pooled phase 3 analysis.
Mechanism
Oxymetazoline is an alpha adrenoceptor agonist targeting adrenoceptors in Müller's muscle of the eyelid.
Dosing
One drop into one or both affected eyes once daily. Discard each single patient-use container right after dosing.
Visual field result
In 304 pooled trial participants, the drop increased points seen on the Leicester Peripheral Field Test by about 4 more than vehicle on day 1.
Lid height result
Marginal reflex distance 1 rose 0.96 mm with the drop versus 0.50 mm with vehicle on day 1.
Warnings
Ptosis may be linked to neurologic or orbital disease. Alpha agonists may affect blood pressure, and angle closure is a listed risk.
Adverse reactions
Punctate keratitis, conjunctival hyperemia, dry eye, blurred vision, instillation site pain, eye irritation and headache.
A chairside workup before prescribing.
What to check and document for every ptosis patient.
| Check | Why | If abnormal |
|---|---|---|
| History of onset and fatigue | Sudden or variable droop can signal neurologic disease | Urgent medical or neuro evaluation |
| Pupils and motility | Horner syndrome and nerve palsies present with ptosis | Refer before treating the lid |
| Levator function and MRD1 | Separates mild acquired ptosis from other causes | Oculoplastic referral when function is poor |
| Anterior chamber angle | The label lists angle closure as a risk | Avoid or monitor closely |
| Blood pressure and medications | Alpha agonists and some cardiac drugs interact | Coordinate with the primary physician |
Upneeq lifts a lid that is working but sitting low. Patients with heavy skin folds, poor levator function or a large droop usually need a surgical consultation instead, so set expectations before the first bottle.
Frequently asked questions
Who is Upneeq for?
Adults with acquired blepharoptosis, after an exam that rules out neurologic and orbital causes.
How fast does it work?
The maker states lids lift in as little as 5 minutes and the effect can last up to 8 hours.
Can patients use it with contact lenses?
Lenses should be removed before instilling the drop and can be reinserted 15 minutes later.
What should I watch for?
The label warns about cardiovascular effects, potentiation of vascular insufficiency, angle closure and contamination of the container tip.
Does it replace ptosis surgery?
No. It is a daily drop with a temporary effect. Patients with significant or functional ptosis may need oculoplastic evaluation.
Can I order Upneeq through Vision Rescue?
Upneeq is not in the Vision Rescue catalog at this time. Follow the manufacturer's instructions for prescribing and dispensing.
References
- RVL Pharmaceuticals. UPNEEQ (oxymetazoline hydrochloride ophthalmic solution) 0.1% Prescribing Information, via DailyMed. DailyMed
- Upneeq. Information for healthcare professionals. Upneeq
- Slonim CB, et al. Oxymetazoline 0.1% and visual field in acquired ptosis: pooled analysis of 2 randomized trials. JAMA Ophthalmol. 2020;138(11):1168-1175. PubMed
- Every source used across these guides is listed on the Vision Rescue sources page.
About this guide
Written for licensed eye care practices by the Vision Rescue team. Questions: providers@visionrescue.com or 1-855-692-8024.
Important notes and disclosures
Information only, not clinical advice. Review the full Prescribing Information, including warnings and precautions, before prescribing. Product names are trademarks of their owners. Clinical decisions rest with the treating eye doctor.
Offer a non-surgical option, safely.
Screen every ptosis patient carefully, prescribe when appropriate and refer when surgery is the better answer.