Mendonça TB, Lummertz AP, Bocaccio FJ, Procianoy F. Effect of Low-Concentration, Nonmydriatic Selective Alpha-Adrenergic Agonist Eyedrops on Upper Eyelid Position. Dermatol Surg. 2017;43(2):270-274. doi:10.1097/DSS.0000000000000967
I frequently receive calls and messages from dermatologists asking for help with botulinum toxin related eyelid ptosis. This is a self-limited condition, and since alpha adrenergic agents may elevate the eyelid by Muller’s muscle stimulus, Apraclonidine use is frequently suggested. It is important to remember that the goal of this treatment is only temporary (partial) compensation of eyelid ptosis while the drug action lasts, not accelerating recovery. Apraclonidine is unavailable in Brazil for many years, so we used to suggest the prescription of other low concentration alpha adrenergic agents as in decongestant eyedrops, or even Brimonidine – a selective alpha-adrenergic glaucoma drug. I was never really sure about the best alternative and the real effect. To elucidate this, we conducted this study, comparing the effect of Brimonidine 0.2%, Naphazoline 0.05% and Phenylephrine 0.12% on eyelid opening. Surprisingly, Phenylephrine and Brimonidine on the tested concentrations did not show any perceivable effect on eyelid opening. Naphazoline caused a mean MRD1 increase of 0.56mm 30 minutes after instillation, which reduced to 0.47mm after 60 minutes and 0.26mm after 120 minutes. Based on these findings, I now suggest the use of Naphazoline 0.05% right before social exposure or photographs once there is limited effect and there is an important reduction of the effect 1 to 2 hours following the eyedrop instillation.