Upneeq (product info and before and after photos) is a first-in-class treatment with a mechanism of action that lifts upper eyelids, drooping due to acquired ptosis (low-lying lids), a common condition that affects adults of all ages. Upneeq lifts the lid’s muscles from one to three millimeters — a difference that can literally be eye-opening!
Upneeq’s active ingredient, 0.1% oxymetazoline hydrochloride, stimulates receptors on the eyelid’s muscles, which trigger a contraction. In clinical trials of once-daily use, patients noticed an improvement in as little as five minutes, with full results in two hours and lasting for about eight hours.
Elevation of the upper eyelid is largely provided by two muscles, the levator palpebrae superioris and the superior tarsal (Muller’s) muscle.
The levator originates from the lesser wing of the sphenoid bone at the orbital apex and inserts onto the anterior surface of the superior tarsal plate. It also attaches to the skin of the upper eyelid, which contribute to the formation of the lid crease.
Unlike the bulky skeletal muscles in your arms and legs, the levator muscle is small, smooth, and atrophies rather than strengthens with overuse, says Raymond Douglas, an aesthetic reconstructive and oculoplastic specialist and global head of scientific affairs for Upneeq. “Once the muscle weakens and the lid drops, it does not restore to the previous level.”
Muller’s muscle receives signals from the sympathetic nervous system and is unique in that it consists of thin fibers of smooth muscle.
Upneeq directly activates a-adrenergic receptors in Muller’s muscle, stimulating contraction and elevation of the upper eyelids.
“Oxymetazoline hydrochloride has been safely used for decades for nasal decongestants, although the concentration in Upneeq is far less,” says Bruce Moskowitz, an assistant clinical professor of ophthalmology at Icahn School of Medicine at Mount Sinai in New York City.
The treatment has a very low incidence of side effects, says Moskowitz — general irritation, dryness, redness, or sensitivity in less than five percent of patients.
NON-SURGICAL PTOSIS TREATMENT OPTION
Surgeries which involve repair of ptosis must be very precise when resecting portions of the upper eyelid and so should be done with careful consideration of the risks vs benefits. Upneeq achieved significant visual field improvement In clinical trials, and has helped patients with acquired ptosis starting on the first day of treatment, making it a viable and cost-effective alternative to surgery.
CLINICAL TRIAL RESULTS
In clinical trials*, UPNEEQ helped patients with acquired ptosis achieve significant visual field improvement:
• 87.8% of patients had some level of improvement.
• 40.8% of patients had at least a 50% improvement on day one (two hours after applying Upneeq).
• On average, UPNEEQ demonstrated three times greater improvement in visual field compared to a placebo in clinical trials, as measured by LPFT on Day l and Day 74 of treatment. (LPFT = Leicester Peripheral Field Test—a measurement of the superior visual field).
* Two randomized, multicenter, double-masked, placebo-controlled, Phase Three studies compared once-daily Upneeq in 304 subjects with acquired blepharoptosis. Efficacy was assessed by points seen in the superior visual field using the LPFT and photographic measurement of Marginal Reflex Distance-7 (MRD-7). There was a statistically significant difference in change in the number of points seen in the superior visual field from baseline after instillation of UPNEEQ and a placebo, with significantly greater increases in the study eye of the Upneeq group evident at the 2-hour point and maintained at the 6-hour time point. Greater eyelid lift (increased MRD-7) was observed for the Upneeq group on Day One at 6 hours post-dose and on Day Seventy-Four at 2 hours post-dose.