Upneeq offers a non-surgical option for acquired blepharoptosis

The social media buzz around Upneeq motivated me to investigate this non-surgical pharmaceutical approach to blepharoptosis.

Based on the excellent results achieved by my team members and myself, we have decided to offer Upneeq (Oxymetazoline Hydrochloride Ophthalmic Solution 0.1%, RVL Pharmaceuticals) to patients.

When left untreated, ptosis affects the upper visual field and has important psychosocial ramifications, causing patients to feel self-conscious about their appearance. Mild to moderate ptosis is common, affecting approximately 12% of the population over the age of 50 (Sridharan et al., Kim et al.). Until now, surgery has been the only effective treatment; as a result, many eye care specialists are reluctant to discuss lower eyelids with patients. An invasive procedure is not appropriate for all patients, and it can be associated with risks such as infection and undercorrection or overcorrection.

Upneeq is the only FDA approved pharmaceutical product indicated for acquired blepharoptosis.

Bring up the topic

Our main concern with the decline was to find a way to bring up the subject of blepharoptosis with the patients; we wanted to avoid any potentially awkward or distressing conversation. Our approach is based on Upneeq information posters, in the pre-test area and in our eye spa, which describe ptosis and ask patients if they notice their eyes appear droopy or drowsy and feel heavy, especially towards the end of the day.

Janelle Davison

For those who want to learn more, we are sharing a product brochure that shows examples of a range of severity, from A to D, with D being the worst. We invite patients to look at themselves in the mirror and rank the amount of droop; this information is added to the patient’s pre-test report routing form. This greatly simplifies the process of introducing gout and eliminates any discomfort; patients wait for the discussion when they see me. While I sometimes strike up a conversation in the exam room, more often than not patients have already expressed interest in the product.

For patients with blepharoptosis who wish to try Upneeq, we instill a drop in both eyes, so that they do not experience asymmetry in their eyelids. My staff uses an iPad to take a photo so they can compare the before and after photos. It usually takes 15 to 20 minutes to see the effect, but I tell patients that in the study it sometimes took up to 60 minutes to 2 hours for optimal results.

If they don’t see a difference in the office, I give them samples and ask them to try it the next day. I make them take another selfie, instill a drop and wait 60 minutes before taking another photo. Before the patient leaves the office, I have a team member who schedules the patient for a week-long teleconsultation before writing the final prescription.

Experience, patient selection

Our experience has been wonderful. Patients were thrilled with their results, and many noticed a dramatic improvement. Instilling gout in the office allows patients to immediately see the benefits and be confident that the product is safe and effective. Upneeq is a great option for ptosis patients who are uninterested or not a good candidate for surgery, but still looking for a younger, more alert appearance.

I have found that a growing number of young patients fear that they will have tired eyes. My demographics of interested patients include those as young as their late twenties to forties with mild ptosis. At 55 years of age and older, patients often present with more moderate sagging. Upneeq can be used as needed, no more than once a day.

Some patients with moderate or borderline severe ptosis choose daily use and have experienced a wider field of view almost immediately. Others use gout for an extra boost when they want to look their best for a special occasion or event. Men have told me that they are starting a new job or giving a presentation for work and that they don’t want to appear drowsy.

Upneeq offers the added benefit of countering the feeling of fatigue and heaviness that patients experience when the tissue and muscle of the drooping eyelid rest on the globe. This not only makes them sleepy, but their eyes are heavy as well. After using gout, these patients report feeling more awake. There is a wide range of patients who can benefit from the product. Blepharoplasties are not permanent, and Upneeq may be a good option for those who have lost the effect of surgery.

Upneeq and ocular surface disease

For my patients with dry eye disease, my goal is to bring their disease under control and at the same time help them have clearer, whiter eyes. Upneeq is a great supplement for patients interested in treatments that can enhance their beauty in a safe and controlled way. Gout is preservative-free, so it won’t exacerbate pre-existing dry eye, but I avoid using it in anyone with uncontrolled eye surface disease.

Upneeq is supplied by the manufacturer’s pharmacy, which makes prescribing simple and streamlined. Patients leave the office with samples, and we let them know that RVL will contact them to arrange the shipment and that there is no obligation on their part.

For more information:

Janelle L. Davison, DO, founder of Brilliant Eyes Vision Center and Premier Dry Eye Spa in Smyrna, Georgia can be contacted at [email protected].

The references:

• Cahill KV, et al. Ophthal Plast Reconstr Surg. 1987; doi: 10.1097 / 00002341-198703030-00001.
• Finsterer J. Plastic surgery. 2003; doi: 10.1007 / s00266-003-0127-5.
• Kim MH, et al. Eye (London). 2017; doi: 10.1038 / eye.2017.43.
• Richards HS, et al. Eye (London). 2014; doi: 10.1038 / eye.2013.264.
• Slonim CB, et al. JAMA Ophthalmol. 2020; doi: 10.1001 / jamaophthalmol.2020.3812.
• Sridharan GV, et al. Age Aging. 1995; doi: 10.1093 / aging / 24.1.21.