Oxymetazoline: A Surgeons Unique Approach for the Treatment of Droopy or Uneven Eyelids

Goals/Purpose: The prevalence of ptosis ranges in different populations between 4.7 and 13.5%. A recent survey has reported that approximately 60% of adult women feel that their eyelids are droopy; ptosis is a common condition that has a significant impact on the aesthetics of the eyelids and the face. Until now the mainstay of treatment for droopy eyelids until now has been purely surgical. Toxin-induced ptosis, a dreaded cause of droopy eyelid, can be treated with apraclonidine 0.5% drops temporarily, but its short duration and potential side effects limit its use. Phenylephrine 2.5% drops used traditionally to aid in surgical planning for ptosis repair also has short duration and side effects (dilation, burning stinging, sensitivity, watering). The purpose is to determine how this recently FDA approved medication for the treatment of acquired ptosis (oxymetazoline) serves as become a useful tool for the management of other types of ptosis and as an aid in patient diagnosis, education and planning.

Methods/Technique: Retrospective Chart review of a single surgeon’s experience of a broad spectrum of cases considering blepharoptosis of multiple etiologies with analysis of planning as well as recommendations for the clinician.

Results/Complications: The use of oxymetazoline is a useful adjunct for treatment of the unilateral or bilateral ptosis but more importantly as a trial for patients who are unsure about surgery or that have moderate dry eye. The fact that the drug also acts by opening the eye in the infrapupillary aspect (ie MRD2) with minimal brow impact can also help with decision making if the patient is considering other facial/eyelid surgery or cosmetic procedures.

Conclusion: The implementation of oxymetazoline ophthalmic solution 0.1% for the plastic surgeon serves as an educational tool for the patient, a sustainable treatment for ptosis patients who either are not good candidates for surgery or do not want surgery and in preparation for surgery. Furthermore, the application of this medication can be extended to asymmetric patients, patients who have toxin induced eyelid ptosis and in combination treatments. The extended duration of the medication and good safety profile merit its inclusion to the aesthetic armamentarium. The low incidence of adverse events of the medication makes it a very attractive option.