Upneeq: uses, doses, and side effects

If one or both of your upper eyelids droop over your eye, people may sometimes think you’re falling asleep. While that may sometimes be the case, your droopy lids may signify a condition called ptosis. It’s often caused by genetics, aging, trauma, or various medical conditions. Until recently, surgery was one of the only options to correct drooping lids.

Now, a new non-surgical treatment called Upneeq is available. 

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Upneeq (oxymetazoline 0.1% ophthalmic solution) is a prescription eye drop available for the treatment of blepharoptosis, also known as ptosis or drooping of the upper eyelid. Mild ptosis is usually a cosmetic concern, but more severe cases can affect your vision. Here are some basic facts about Upneeq (DailyMed, 2022):

• Active ingredient and strength: oxymetazoline hydrochloride 0.1% 

• Typical dose: 1 drop into the affected eye (or eyes) once daily

• Form: single-use, preservative-free containers that you use to apply the drop to your eye(s) and discard after each dose

• Cost: average retail price of $263.32 for a carton of 30 single-use containers (GoodRx, 2022)  

The Food and Drug Administration (FDA) approved the drug in July 2020, making Upneeq the first-ever eyelid-lift-in-a-bottle (RVL Pharmaceuticals, 2020). Specifically, Upneeq is FDA-approved for the treatment of acquired ptosis. “Acquired” means that you were not born with sagging eyelids, but they started drooping later in life. Common causes of acquired ptosis include aging, genetics, surgery, Botox injections, medical conditions, or trauma—anything that thins or weakens the muscles above your eyelid (Shahzad, 2022; King, 2016).

Upneeq contains the active ingredient oxymetazoline and belongs to a drug class known as alpha receptor agonists. It works by targeting an eyelid muscle called Muller’s muscle. The drug causes Muller’s muscle to tighten, thereby lifting the low-lying eyelid (DailyMed, 2022). 

Uneeq is the only FDA-approved eyedrop for drooping eyelids. It can be prescribed for cosmetic reasons or to help improve your field of vision if your low-lying lids get in the way. One of the advantages of Upneeq is how fast it works. In clinical studies, some people saw their lids lift within minutes to two hours after their first dose. The downside is that the effects are temporary—the once-daily drop keeps working for about 6–8 hours. So, you’ll see your lid droop again as the drug wears off and your eyelid muscles relax (DailyMed, 2022; Heymann, 2022). 

Upneeq is an eye drop typically used once daily. Be sure to follow your provider’s instructions for using Upneeq. Here are the basic steps (DailyMed, 2022):

1. Wash your hands before administering the drops.

2. If you have contact lenses, remove them. You can put them back in 15 minutes after applying Upneeq.

3. Squeeze one drop into the affected eye(s) once a day, being careful not to touch the dropper end of the container to your eye or any other surface.

4. Discard the single-use container even if you have some leftover solution.

If you use any other prescription eye drops or over-the-counter eye medicines, you should use them at least 15 minutes apart from Upneeq.

In Upneeq’s clinical trials, most people had minimal side effects. Only 1–5% of trial participants experienced the following adverse reactions (DailyMed, 2022):

• Punctate keratitis (a sign of eye inflammation)

• Eye redness

• Dry eye

• Blurred vision

• Eye pain at the instillation site (the spot where the medicine drops into your eye)

• Eye irritation

• Headache

No serious side effects were reported in studies of the drug; these side effects typically go away when you stop using the medication. 

Upneeq may not be safe for everyone. Before prescribing Upneeq, your healthcare provider will review your health history, including any treatments you receive for medical conditions. While eye drops mainly work in your eye and surrounding tissues, this medication’s drug class (alpha-agonists) carries potential warnings for people with (DailyMed, 2022):

• Cardiovascular disease, since alpha agonists as a class can affect blood pressure. If you have heart disease, high blood pressure, or low blood pressure, let your provider know if your symptoms worsen

• Blood vessel problems, such as Sjögren’s syndrome

• Glaucoma. If you have a condition called narrow-angle glaucoma and are not being treated for it, you may be at an increased risk of worsening symptoms due to Upneeq. 

Your healthcare provider will also want to know about any other medication or supplements you take. The following types of drugs carry warnings regarding taking with Upneeq (DailyMed, 2022):

• Blood pressure medications. Since alpha agonists can affect blood pressure, be careful using Upneeq if you also take blood pressure drugs. Examples of blood pressure drugs include beta blockers (drugs ending in “-olol,” such as metoprolol) and ACE inhibitors like lisinopril.

• Monoamine oxidase inhibitors (MAOIs). People who take MAOIs should be careful when using Upneeq because the combination could potentially affect drug breakdown. Examples include linezolid (Zyvox), selegiline, and phenelzine.  

Also, before prescribing Upneeq, your healthcare provider will want to determine the cause of your sagging lids. In some cases, droopy eyelids can be a sign of a more serious medical problem like Horner’s syndrome, myasthenia gravis, stroke, or infection. Your healthcare provider can help determine if Upneeq is safe for you.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

November 08, 2022

Written by

Patricia Weiser, PharmD

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.