Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Upneeq is a prescription medication used to treat ptosis, which is a medical term for drooping of the eyelids. According to their website, it’s the only Food and Drug Administration (FDA) approved drug to treat this condition.
Upneeq is an eyedrop medication rather than an oral medication like most of the prescription drugs we’ve reviewed on Illuminate Health. The generic name for Upneeq is oxymetazoline hydrochloride ophthalmic solution 0.1%. Upneeq is just the branded version of this medication. These two terms refer to the same active ingredient, so we will use them interchangeably throughout this article.
In this article we’ll review the medical studies on Upneeq to determine if it’s a safe and effective treatment for drooping eyelid. We’ll highlight some of the side effects of the medication and share some before-and-after images from the manufacturer.
Does Upneeq Work?
Ptosis, short for blepharoptosis, can affect both the aesthetic appearance and function of the eyes. According to the American Academy of Ophthalmology, it can limit or block vision.
For a ptosis medication to work, ideally it would improve both the vision and the appearance of the eyes and eyelid.
A medical review published in the JAMA Ophthalmology journal examined how Upneeq could improve visual field. The study authors found that patients using Upneeq had a significant improvement compared to patients using placebo.
The researchers used a standard called the Leicester Peripheral Field Test to gauge how many points in a user’s vision that they could successfully identify. The number of points that the trial participants could see was more than doubled when using Upneeq when compared to placebo treatment, from 1.8 points on average seen to 5.9 points.
A more recent clinical trial published in 2021 examined the effects of Upneeq for treating eyelid drooping. 304 patients with acquired blepharoptosis were evaluated in total. The eyelid elevation seen in the Upneeq patient group was superior to that from the placebo group to a statistically significant degree.
15 minutes post-treatment on day 1 of the trial, the eyelid change from baseline was 0.93 millimeters (mm) in the Upneeq group versus 0.32 mm in the placebo group. 15 minutes post-treatment on day 14 of the trial, the eyelid change was 1.11 mm in the Upneeq group and only 0.41 mm in the placebo group. These results suggest that Upneeq improved eyelid drooping by over 100% compared to placebo.
We can conclude from the available research that Upneeq is likely to be effective for both improving vision and improving eyelid appearance in patients with ptosis. This doesn’t mean that it will work for every patient; just that it works on average.
How Does Upneeq Work?
The active chemical compound in Upneeq was initially prescribed as a nasal decongestant, and its use for treating ptosis is recent. Thus researchers aren’t entirely sure of the exact mechanism of action, but there are some suggestions in the medical literature.
The first-linked research review from the previous section includes a section where the study authors hypothesize that Upneeq may cause contraction of a muscle that is weakened or dysfunctional in patients with ptosis. Once this muscle is contracted, the eyelid is lifted like a lever: “It is hypothesized that oxymetazoline, 0.1%, stimulates α-adrenergic receptors on Müller muscle.”
Upneeq appears to work due to a nervous system response to the medication, because the weakened muscle which causes ptosis is not directly in contact with the topical treatment.
Upneeq Side Effects
The safety of Upneeq has been extensively studied in medical trials. Like nearly all drugs approved by the FDA, Upneeq has been proven to be safe in most patients. But that doesn’t mean it’s free of side effects.
A recent medical review analyzed the safety of Upneeq based on results from four individual clinical trials. The total adverse event ratio was 31.2% in patients using Upneeq and 30.6% in patients using placebo. This means that only 0.6% more patients reported side effects on the active medication than on placebo. This is a relatively low “true” side effect ratio compared to most medications we’ve reviewed.
The most common side effects on Upneeq were punctate keratitis (a relatively minor eye disease), excess of blood vessels in the eye, dry eyes and blurry vision. None of these side effects were experienced by more than 3.5% of the study population.
98% of patients across all trials reported no or “mild” side effects.
Is Upneeq Better Than Surgery?
One of the most common treatments for ptosis is corrective surgery which repositions the eyelid. This surgery may treat the root cause of the disorder, but it also carries a risk of complications. A medical review of blepharoptosis treatment called this surgery “perhaps the most challenging in the field of oculoplastics.”
This surgery carries risks such as orbital hemorrhage, where bleeding in the eye can cause permanent vision loss. There’s also around a 10% risk that the surgery is done improperly and a second corrective surgery is required.
In our opinion, Upneeq seems like a superior first-line treatment to surgery given its low risk and relatively mild side effect profile. It’s also much cheaper. We would recommend that patients speak with their doctor about Upneeq at least during a trial period before considering surgery.
Upneeq is relatively expensive without health insurance. GoodRx reports that the average price is above $200 at the time of writing this article for one carton (0.3 milliliters) of Upneeq.
Upneeq’s website details that their medication is also available for purchase directly from medical providers. We recommend that patients speak with both their doctor and their health insurer prior to purchasing Upneeq to see if they can get a reduced price for the medication.
Upneeq User Reviews
Drugs.com is a good resource for finding user reviews of a prescription medication. We cannot guarantee the authenticity of these reviews, but it seems logical that most of them would be legitimate because there’s not much incentive to write a review of a drug that you never tried.
There’s only one user review of Upneeq on Drugs.com and it’s a favorable review with a 9 out of 10 star rating. A user called “Kima” was impressed with the aesthetic benefit that the medication provided:
“I like the “opened-eye” look one drop a day gives me. Didn’t realize how sleepy I looked before my Opthomologist recommended for one eyelid that was drooping a bit. We discovered I needed one drop in each eye, otherwise my eyes looked uneven.”
One of the most popular user reviews of Upneeq is from a YouTube creator whose channel is called “Gorgeously Aging Advanced.” They were prescribed Upneeq and use the medication on camera. They explain the effects to users and provide some before-and-after images:
Upneeq Before and After Images
One of the most commonly asked questions from patients about this medication is whether there are before-and-after images available. Because ptosis can cause facial asymmetry, many patients are as concerned if not more about the potential aesthetic benefit of this medication than the vision benefit.
Upneeq provides before-and-after images of real patients who used their medication, which can be seen below:
Another popular before-and-after image comes from a TikTok user called “despratelyseekindopamine” who used the medication and took images before, after 15 minutes and after 2 hours: https://www.tiktok.com/@despratelyseekindopamine/video/7007447496041450757