Upneeq (oxymetazoline) is an FDA-approved, prescription eye drop that temporarily improves droopy eyelids (aka ptosis) caused by a weak muscle in the upper eyelid.
Low-lying eyelids can be a cosmetic concern—they can make you look tired or sad—or a functional issue that restricts your vision.
Upneeq contracts one of the eyelid muscles that elevates the eyelid, allowing the eyelid to open 1–2 millimeters (mm) wider—enough to create a noticeable difference.
Dubbed “the drop and lift,” the medication is used once a day. Results are typically seen within 15 minutes and last 6–8 hours. Upneeq provides an alternative to neurotoxins like Botox, or ptosis surgery, previously the only options for raising droopy eyelids.
Upneeq (oxymetazoline hydrochloride ophthalmic solution, in medical terms) is a “vasoconstrictive”—in other words, it constricts blood vessels. This active ingredient is also found in nasal sprays like Afrin, says Dr. Tanya Khan, an oculoplastic surgeon in Plano, Texas. As a decongestant, oxymetazoline shrinks blood vessels in the nasal passages to allow air to pass through more easily. “In the upper eyelid, Upneeq works by activating the Muller’s muscle, which helps elevate the eyelid, resulting in approximately 2 mm of lift,” Dr. Khan explains.
About 10–12% of adults have a droopy eyelid, so it’s a common problem. But not everyone is a good candidate for Upneeq.
For instance, Upneeq works only on cases of acquired ptosis (meaning the condition develops later in life, often as a function of aging); it’s not a treatment for congenital ptosis, which is present at birth.
According to Dr. Khan, the temporary lift Upneeq provides makes it a good option for people who:
People with severe ptosis—those who’d need more than 2 mm of lift—are not ideal candidates. Nor are people who have drooping eyelids due to excess skin, saggy eyebrows, or underlying eye injury or nerve problems; Upneeq won’t help in these cases.
Pros
Cons
Upneeq costs between $220 and $250 for a 45-day supply in the U.S. That translates to between $4.90 and $5.56 per day.
It’s possible to find coupons online. You can also cut your Upneeq eye drops costs by setting up an ongoing subscription. Dr. Khan recommends trying it for a month or two and then assessing whether you want to consistently use it or consider eyelid surgery instead.
Insurance will not cover the cost of Upneeq, either as an elective cosmetic treatment or to treat medical conditions like ptosis. Even though it’s FDA-approved for medical use, insurance companies like Cigna still consider it “experimental, investigational, or unproven.” This stance may change as more long-term data becomes available.
Upneeq is easy to use.
According to the FDA, Upneeq is safe and effective for the treatment of acquired eyelid ptosis in healthy adults. To gain approval, Upneeq showed effectiveness in four clinical trials that followed 568 patients with acquired blepharoptosis.
In the clinical trials, oxymetazoline 0.1% was administered once daily for 14-84 days. The most common side effects of Upneeq (occurring in 1–5% of patients) were:
While most side effects are mild, Upneeq may not be right for everyone, especially those with underlying medical conditions.
You can get a prescription online without being seen by a doctor, and many types of physicians offer it, which concerns some eye specialists. “Any patient who’s being prescribed Upneeq should be evaluated by an ophthalmologist,” advises Dr. Khan. “Acquired blepharoptosis has a broad differential diagnosis, which can include certain underlying neurological conditions of an acute nature—such as Horner’s syndrome, stroke, and mixed cranial nerve palsy—that should be ruled out prior to masking a potentially life-threatening issue with an eye drop.”
Another consideration: daily use may not be healthy long-term. “Our eye’s blood vessels have a critical role in delivering oxygen and nutrients for proper functioning of the eye’s tissues and tear film to optimize our vision,” Dr. Khan explains.
Regular use of Upneeq may lead to rebound redness, when the blood vessels stop reverting back to their original size once the drug wears off. A rebound effect wasn’t seen in Upneeq studies, but it’s a possibility, since the active ingredient in Upneeq may constrict blood vessels.
Another possibility is rebound congestion. “It’s a probable adverse outcome, as it is for Afrin nasal spray, which is routinely recommended for only 2-3 consecutive days because it can cause worsening of congestion after that time frame,” says Dr. Khan.
Due to these concerns, some providers don’t consider Upneeq a good long-term option and only prescribe it for a few weeks. Discuss with your doctor how long it’s appropriate for you to use Upneeq.
Updated June 13, 2023