Is It Worth Using Botulinum Toxin Injections for the Management of Mild to Moderate Blepharoptosis?

The Use of Oxymetazoline 0.1% Ophthalmic Solution for Acquired Blepharoptosis: A Systematic Review

OBJECTIVE

Oxymetazoline hydrochloride has been shown to be effective in some studies for acquired blepharoptosis and for aesthetic upper eyelid elevation. This study aims to systematically review the literature on the use of topical oxymetazoline for treating acquired blepharoptosis.

DATABASES REVIEWED

PubMed (U.S. National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane.

METHODS

A systematic review of studies published between 2013 and 2024 following PRISMA guidelines was performed using the PubMed, Scopus, and Cochrane databases. Primary outcomes included pre- to posttreatment change in marginal reflex distance (MRD1) after treatment with topical oxymetazoline, and mean difference (pre-to-posttreatment) in MRD1 versus control.

RESULTS

Five articles included data from 458 patients for analysis. Meta-analysis demonstrated significant improvement in MRD1 measurements posttreatment with oxymetazoline (1.40 mm; 95% confidence interval, CI [0.41 mm, 2.40 mm]). In addition, when compared to controls, patients treated with oxymetazoline demonstrated greater increase in MRD1 values (0.83 mm; 95% CI [0.10 mm, 1.55 mmm]). Heterogeneity, measured by I2 statistic, was high in all studies (85%-95%).

CONCLUSION

The use of oxymetazoline 0.1% ophthalmic solution significantly improves MRD1 in patients with acquired blepharoptosis. Further studies comparing this treatment in other etiologies of acquired blepharoptosis should be conducted. Laryngoscope, 135:8-14, 2025.

Botulinum Toxin: A Non-surgical Approach for Non-myasthenic Mild-to-Moderate Blepharoptosis Treatment

INTRODUCTION

Mild-to-moderate blepharoptosis can be aesthetically displeasing for patients, particularly in cases involving a single eyelid. However, certain patients are reluctant to undergo surgical intervention. Botulinum neurotoxin A (BoNT-A) injection offers a potential solution in such cases.

MATERIAL AND METHODS

Patients meeting the following inclusion criteria were included in the study: mild-to-moderate eyelid ptosis of different etiologies (excluding myasthenic disorders), robust activity of the orbicularis oculi muscle, proficiency in Italian language, standardized pre- and postoperative photo-documentation, and signed consent for study participation. A 32-33 Gauge 4-mm needle was employed to inject the BoNT-A in the pretarsal orbicularis muscle. Standardized videos and photos were obtained before the treatment, 2 weeks, 4 weeks, and 24 weeks post-treatment. Outcomes were evaluated by measuring changes in the margin reflex distance-1 (MRD-1) and assessing patient point of view through two subjective questionnaires.

RESULTS

Forty-nine patients were enrolled, 39 females and 10 males, aged between 30 and 88 years old. We observed a significant increase in the MRD-1 after 2 weeks and after 4 weeks compared to the baseline (p < 0.0001), with a mean elevation of the eyelid of 0.71 mm and 0.67 mm respectively. Patients ceased to require furrowing of the frontalis muscle to compensate for the eyelid elevation dysfunction. After 24 weeks, the BoNT-A effect diminished, and the treated eyelid returned to its baseline position. 67.4% of patients reported an improvement with only mild inconvenience in their blepharoptosis, and 16.3% of patients reported a complete improvement. 85.7% of patients expressed the desire to undergo the treatment again.

CONCLUSIONS

BoNT-A has demonstrated effectiveness in temporarily managing mild-to-moderate blepharoptosis and may represent a viable option for addressing minor eyelids asymmetries.

LEVEL OF EVIDENCE II

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