Pharmacologic Agents Used in the Assessment or Correction of Blepharoptosis: A Report by the American Academy of Ophthalmology.

Abstract

To review the literature to determine the efficacy and safety of pharmacologic agents for the short-term (minutes to hours) correction of blepharoptosis. 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. 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. 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. The author(s) have no proprietary or commercial interest in any materials discussed in this article.