Disclosures: Davison reports serving on various medical advisory board panels for RVL Pharmaceuticals.
October 20, 2021
4 min read

Upneeq offers nonsurgical option for acquired blepharoptosis

Disclosures: Davison reports serving on various medical advisory board panels for RVL Pharmaceuticals.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

The buzz on social media around Upneeq motivated me to investigate this nonsurgical, pharmaceutical approach to blepharoptosis.

Based on the excellent results members of my staff and I experienced, we decided to offer Upneeq (oxymetazoline hydrochloride ophthalmic solution 0.1%, RVL Pharmaceuticals) to patients.

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

Upneeq represents the only FDA-approved pharmaceutical indicated for acquired blepharoptosis.

Approaching the topic

Our main concern with the drop was finding a way to broach the topic of blepharoptosis with patients; we wanted to avoid any potentially awkward or distressing conversations. Our approach leverages Upneeq informational posters, in the pretesting area and in our eye spa, that describe ptosis and ask patients if they notice their eyes looking droopy or sleepy and feeling heavy, particularly toward the end of the day.

Janelle Davison

For those who are interested in learning more, we share 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 in the mirror and rank the amount of droop; that information is added to the patient’s pretest workup routing form. This greatly simplifies the process of introducing the drop and eliminates any awkwardness; patients are expecting the discussion when they see me. Although I sometimes initiate the conversation in the exam room, most often 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 they do not experience asymmetry of their lids. My staff uses an iPad to take a picture so they can compare the before and after photos. It typically takes 15 to 20 minutes to see the effect, but I tell patients that in the study it sometimes took as long as 60 minutes to 2 hours to achieve maximum results.

If they do not see a difference in the office, I give them samples and direct them to try it the next day. I have them take another selfie, instill a drop and wait 60 minutes before taking another picture. Before the patient leaves the office, I have a team member schedule the patient for a 1-week teleconsultation before writing the final prescription.

Experience, patient selection

Our experience has been great. Patients have been excited about their results, and many have noticed dramatic improvement. Instilling the drop in the office allows patients to see the benefit right away and feel confident that the product is safe and effective. Upneeq is a great option for patients with ptosis who are either not interested in or not good candidates for surgery but are still looking for a more youthful and wide-awake appearance.

I have found that an increasing number of younger patients are concerned about having tired-looking eyes. My demographic of interested patients includes those as young as late 20s to 40s with mild ptosis. By the time they are 55 years and older, patients often have a more moderate droop. Upneeq can be used on an as-needed basis, no more than once a day.

Some patients with moderate or borderline severe ptosis choose daily use and have enjoyed a wider field of view almost immediately. Others use the drop for an added boost when they want to look their best for a special occasion or event. I have had men say they are starting a new job or doing a presentation for work and do not want to appear sleepy.

Upneeq provides an additional benefit of counteracting the tired and heavy feeling that patients get when the drooping lid tissue and muscle sit on the globe. This not only makes them look sleepy, but it also causes their eyes to feel heavy. After using the drop, these patients say they feel more wide awake. There is a broad range of patients who can benefit from the product. Blepharoplasties are not permanent, and Upneeq can be a good option for those who have lost the effect of surgery.

Upneeq and ocular surface disease

For my patients with dry eye, my goal is to get their disease under control and at the same time help them get clearer, whiter eyes. Upneeq is a great complement for those patients interested in treatments that can enhance their beauty in a safe and controlled manner. The drop is preservative free, so it will not exacerbate preexisting dry eye, but I avoid using it in anyone with uncontrolled ocular surface disease.

Upneeq is supplied through the manufacturer’s pharmacy, making prescribing simple and streamlined. Patients leave the office with samples, and we let them know that RVL will contact them to set up shipping and that there is no commitment on their part.

For more information:

Janelle L. Davison, OD, founder of Brilliant Eyes Vision Center and Premier Dry Eye Spa in Smyrna, Ga., can be reached at dr.davison@brillianteyesvisioncenter.com.


  • Cahill KV, et al. Ophthal Plast Reconstr Surg. 1987;doi:10.1097/00002341-198703030-00001.
  • Finsterer J. Aesthetic Plast Surg. 2003;doi:10.1007/s00266-003-0127-5.
  • Kim MH, et al. Eye (Lond). 2017;doi:10.1038/eye.2017.43.
  • Richards HS, et al. Eye (Lond). 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 Ageing. 1995;doi:10.1093/ageing/24.1.21.