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FDA approved UPNEEQ®

UPNEEQ® is an FDA-approved prescription eye drop designed to temporarily lift droopy eyelids caused by weakened muscles in the upper lid.1 Its active ingredient, oxymetazoline, targets Müller’s muscle – one of the muscles involved in elevating the eyelid – causing it to contract and lift the lid by 1-2 millimeters.1,2 This effect typically begins within 15 minutes and lasts 6 – 8 hours, making it ideal for mild ptosis.1,2

Understanding Acquired Ptosis

Acquired blepharoptosis refers to drooping of the upper eyelid.3

Severity ranges from mild (1–2 mm droop) to severe (complete pupil coverage).4

Symptoms of Acquired Ptosis

Acquired ptosis often develops gradually and may present with:4

  • Unilateral or bilateral eyelid drooping, obstructing the upper visual field
  • Asymmetrical appearance or a “tired” look, even after rest
  • Difficulty with daily activities (e.g., reading, driving) due to lid obstruction
  • Compensatory mechanisms like head tilting or brow strain to improve vision

Unlike congenital ptosis (present at birth), acquired ptosis commonly arises from age related stretching, dehiscence or disinsertion of the levator aponeurosis (the tendon-like structure connecting the eyelid levator muscle to the overlying tissue). Other acquired causes to rule out includes:4,5

  • Mechanical causes (ie. chalazion, eyelid mass, scarring secondary to inflammation or previous lid surgery or ocular trauma)
  • Neuromuscular causes (ie. myasthenia gravis)
  • Neurogenic causes (ie. third nerve palsy or Horner’s Syndrome)

Evaluation and Diagnosis

A comprehensive assessment by an oculoplastic surgeon is critical to determine the cause and severity. Key steps include:5

  1. Medical History Review: Discussion of trauma, autoimmune disorders, or neurological conditions (e.g., myasthenia gravis, Horner syndrome)
  2. Eyelid Measurements:
    • Margin Reflex Distance 1 (MRD1): Distance from the upper eyelid margin to the corneal light reflex
    • Levator Function Test: Evaluates muscle strength; poor function may indicate surgical candidacy
  3. Visual Field Testing: Quantifies vision obstruction with eyelids taped vs. untaped
  4. Pharmacologic Testing: Response to phenylephrine eye drops helps identify Müller’s muscle responsiveness
UPNEEQ® is not suitable for all types of ptosis. It is specifically indicated for acquired cases caused by Müller’s muscle dysfunction and should only be used after evaluation by an oculoplastic surgeon.

Who is a Candidate for UPNEEQ®

Upneeq is ideal for patients with:6

  • Mild age-related ptosis (1–2 mm droop) affecting one or both eyes
  • A desire for a non-surgical, reversible option
  • Temporary eyelid lift for cosmetic or functional improvement

Benefits and Limitations of UPNEEQ®

Benefits6

  • Non-invasive: Avoids risks associated with surgery, such as scarring or prolonged recovery
  • Rapid results: Works within 15 minutes
  • Customizable: Can be applied to one or both eyes to address asymmetry
  • Well-tolerated: Side effects like dry eyes or blurred vision are rare (1–5% of users)

Limitations6

  • Temporary effect: Requires daily application
  • Mild cases only: Not effective for moderate-to-severe ptosis
  • Not a cure: Does not address the underlying cause of muscle weakness

Regulatory Status and Availability in Canada

While UPNEEQ® is FDA-approved in the U.S. since July 2020, it is not yet Health Canada-approved. Availability in Canada remains limited. North Toronto Eye Care’s oculoplastic surgeons can assess eligibility and explore alternative treatments, including ptosis surgery, for patients outside UPNEEQ’s scope.

Why Consult Our Oculoplastic Surgeons?

UPNEEQ® is not Health Canada-approved and availability here is limited. Oculoplastic surgeons bridge functional and cosmetic care, addressing conditions that impair vision or facial harmony. The importance lies in precise diagnosis and tailored treatment, particularly for complex eyelid disorders like ptosis and blepharochalasis (excess eyelid skin), which often overlap and require expert differentiation.7

Our surgeons at North Toronto Eye Surgical Centre provide :

  • Personalized Assessments: To determine if Upneeq, surgery, or other therapies are suitable.
  • Surgical Expertise: For lasting correction of ptosis.
For More Information on Ptosis Correction
For More Information on Eyelid Surgery (Blepharoplasty)

Take Action: If eyelid drooping affects your vision or confidence, schedule a consultation at North Toronto Eye Care. Whether through innovative drops or advanced surgery, early intervention ensures optimal outcomes for improving both function and quality of life.

References

  1. https://www.upneeq.com
  2. https://www.aao.org/eye-health/news/first-prescription-fix-droopy-eyelid
  3. https://www.aao.org/eye-health/diseases/what-is-ptosis
  4. https://eyewiki.org/Blepharoptosis
  5. https://www.ncbi.nlm.nih.gov/books/NBK539828
  6. https://www.upneeq.com/hcp/acquired-ptosis
  7. Bacharach J, Lee WW, Harrison AR, Freddo TF. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye (Lond). 2021 Sep;35(9):2468-2481. doi: 10.1038/s41433-021-01547-5. Epub 2021 Apr 29. PMID: 33927356; PMCID: PMC8376882.
  8. Farber SE, Codner MA. Evaluation and management of acquired ptosis. Plast Aesthet Res. 2020;7:20. http://dx.doi.org/10.20517/2347-9264.2020.05