Pharmacologic Agents Used in the Assessment or Correction of Blepharoptosis: A Report by the American Academy of Ophthalmology. Ophthalmology 2025 Jun;132(6):718-730
Date
04/02/2025Pubmed ID
40172501DOI
10.1016/j.ophtha.2025.01.018Scopus ID
2-s2.0-105001880552 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
OBJECTIVE: To review the literature to determine the efficacy and safety of pharmacologic agents for the short-term (minutes to hours) correction of blepharoptosis.
METHODS: A literature search was conducted last in the PubMed database in July 2024 to identify all studies in the English language on the use of pharmacologic agents for the correction of blepharoptosis. The search yielded 197 citations, and 26 articles met all of the inclusion criteria for this assessment. Case reports and small case series were excluded. A panel methodologist then assigned a level of evidence rating for each of the included studies.
RESULTS: Four studies were rated level I, 4 studies were rated level II, and 18 studies were rated level III. Medications that provided short-term improvement in blepharoptosis included phenylephrine, cocaine, hydroxyamphetamine, apraclonidine, naphazoline, and oxymetazoline. Phenylephrine, cocaine, and hydroxyamphetamine were used only in the office for diagnostic purposes. No serious, treatment-related adverse events were noted in the studies included in this assessment. Adverse events reported included dry mouth and dry nose with apraclonidine and punctate keratitis and blurred vision, conjunctival hyperemia, dry eye, and instillation site pain with oxymetazoline.
CONCLUSIONS: Phenylephrine, cocaine, hydroxyamphetamine, apraclonidine, naphazoline, and oxymetazoline can achieve short-term blepharoptosis correction. Phenylephrine, cocaine, and hydroxyamphetamine have been described only in the context of in-office evaluation of blepharoptosis or Horner syndrome, and their therapeutic role remains uncertain. Oxymetazoline hydrochloride ophthalmic solution 0.1% is the only medication approved by the United States Food and Drug Administration for treatment of acquired blepharoptosis in adults. Independent validation studies may be warranted for oxymetazoline hydrochloride and its long-term efficacy and safety data remain uncertain.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Author List
Grob SR, Tao JP, Aakalu VK, Foster JA, Dagi Glass LR, McCulley TJ, Vagefi MR, Yoon M, Kim SJ, Wladis EJAuthor
Vinay Kumar Aakalu MPH, MD Chair, Professor in the Ophthalmology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Academies and InstitutesBlepharoptosis
Humans
Ophthalmic Solutions
Ophthalmology
Phenylephrine
United States
