Use of Upneeq for ocular pathologies offering more than meets the eye

In a presentation at the American Academy of Optometry 2021 annual meeting in Boston, 

Kamila Mikos, OD, and Harriette Canellos, OD, FAAO, from the SUNY College of Optometry, New York, reported that oxymetazoline hydrochloride (UpNeeq, RVL Pharmaceuticals) is useful for more than just treating acquired blepharoptosis and the drug can be used for ocular pathologies that cause blepharoptosis.

Oxymetazoline hydrochloride is a topical ophthalmic medication approved to treat acquired blepharoptosis as an alternative to surgical intervention.

Mikos and Canellos reported that the formulation also is effective for treating patients with etiologies that can result in blepharoptosis, ie, blepharoptosis associated with ocular surgery, myotonic muscular dystrophy, and Bell’s palsy.

In 1 case, a 63-year-old woman presented for evaluation of bilateral blepharoptosis that was worse in the right eye. The patient said the blepharoptosis occurred after cataract surgery about 1.5 years previously. The upper lid margin to reflex distance (MRD1) was measured in both eyes. Before oxymetazoline hydrochloride drops were instilled, the right eye ptosis measured at the MRD1 in the right eye was 1.5 mm, and that in the left eye 2.0 mm. After drop instillation, the respective measurements were 3.6 mm and 4.0 mm.

A second case was that of a 45-year-old woman who presented with the complaint of bilateral ptosis secondary to adult-onset myotonic muscular dystrophy type 1. The patient said that the superior vision was negatively affected and inquired about non-invasive treatment. Before the drops were instilled, the MRD1 values in the right and left eyes, respectively, were 0.5 mm and 0.1 mm. There was insufficient but symmetric levator muscle function. After drop instillation of 1 vial of the drug, the respective measurements were 2.5 mm and 2.3 mm.

In the last case, a 50-year-old woman presented with ptosis evaluation in the right eye of about 2 years duration. She had a history of right-sided Bell’s palsy 6 years previously, secondary to Lyme disease. The Bell’s palsy resolved in about 2.5 weeks with steroid treatment. The patient wore rigid gas-permeable contact lenses and reported difficulty removing the lens from the right eye after the Bell’s palsy developed. She also reported that the ptosis worsened with fatigue and reading at night. Before drop instillation, the MRD1 values in the right and left eyes, respectively, were 1.0 mm and 3.0 mm. After instillation of 1vial of the drug, the respective values were 3.0 mm bilaterally. The elevated lid crease in the right eye was consistent with levator dehiscence, the investigators noted.

Based on the cases, the investigators concluded that blepharoptosis can cause superior visual field defects that can impact a patient’s quality of life.

“Oxymetazoline works directly on alpha-adrenergic receptors to stimulate Muller muscle contraction,” they wrote. “The results in our cases showed that oxymetazoline hydrochloride can be successful in blepharoptosis for a variety of etiologies. Oxymetazoline can now be considered as a potential option to avoid or delay surgery in many cases of ptosis.”

This report is adapted from a poster presentation by Mikos and Canellos at the American Academy of Optometry 2021 annual meeting in Boston. They have no financial interests in this subject matter.