Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug 23:19:2955-2964.
doi: 10.2147/OPTH.S529633. eCollection 2025.

Efficacy of Oxymetazoline 0.1% in Acquired Blepharoptosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Razan O Bawazir  1   2 , Jumanah T Qedair  1   2 , Ziad M Bukhari  3 , Orjwan S Badghaish  1   2 , Rahaf A Hubayni  1   2 , Ali S Alsudais  1   2 , Mohammed F Qutub  2   3
Affiliations
Review

Efficacy of Oxymetazoline 0.1% in Acquired Blepharoptosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Razan O Bawazir et al. Clin Ophthalmol. .

Abstract

Purpose: Abnormal eyelid drooping is a defining feature of blepharoptosis, a disorder that can affect the superior vision field. The standard of care is surgical intervention but may be associated with complications. There is emerging evidence that the direct-acting α-adrenergic agonist ophthalmic solution, oxymetazoline, is effective for blepharoptosis. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of oxymetazoline in the management of blepharoptosis.

Patients and methods: A total of five databases were searched. The inclusion was limited only to randomized controlled trials (RCTs) that evaluated the efficacy of oxymetazoline versus placebo. The efficacy endpoint was the mean change in the marginal reflex distance 1 (MRD 1) from baseline. The safety endpoints were mortality and adverse events (AEs). The weighted mean difference (WMD) was implemented for continuous outcomes. For risk of bias assessment, the Revised Cochrane risk of bias tool for randomized trials was used.

Results: 4 RCTs (n = 448) met the eligibility criteria. The meta-analysis yielded a statistically significant higher difference in the WMD in the oxymetazoline group [0.65 mm (95% CI: 0.44 mm to 0.86 mm)] compared to the placebo group [0.26 mm (95% CI: 0.30 mm to 0.48 mm) [p=0.012]. There were no statistically significant differences between the oxymetazoline group [1.2% (95% CI: 0.4-3.6%)] and the placebo group [1.6% (95% CI: 0.5-5.3%), p = 0.73] in terms of serious adverse events.

Conclusion: Oxymetazoline is an effective and safe medication in the management of acquired blepharoptosis.

Keywords: alpha-adrenergic; eyelid drooping; oculoplastic; oxymetazoline 0.1%; ptosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Funnel plots of (a) MRD1 and (b) LPFT outcomes.
Figure 2
Figure 2
PRISMA flowchart for articles screening process.
Figure 3
Figure 3
Risk of bias graph. Review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Figure 4
Figure 4
Risk of bias summary.
Figure 5
Figure 5
Forest plots of mean change in MRD1 measurements.
Figure 6
Figure 6
Forest plots of mean change in LPFT measurements.
See this image and copyright information in PMC

References

    1. Bacharach J, Lee WW, Harrison AR, Freddo TF. A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye. 2021;35(9):2468–2481. doi: 10.1038/s41433-021-01547-5 - DOI - PMC - PubMed
    1. Thakker MM, Rubin PA. Mechanisms of acquired blepharoptosis. Ophthalmol Clin North Am. 2002;15(1):101–111. doi: 10.1016/s0896-1549(01)00005-0 - DOI - PubMed
    1. Hashemi H, Khabazkhoob M, Emamian MH, et al. The prevalence of ptosis in an Iranian adult population. J Curr Ophthalmol. 2016;28(3):142–145. doi: 10.1016/j.joco.2016.04.005 - DOI - PMC - PubMed
    1. Kim MH, Cho J, Zhao D, et al. Prevalence and associated factors of blepharoptosis in Korean adult population: the Korea national health and nutrition examination survey 2008-2011. Eye. 2017;31(6):940–946. doi: 10.1038/eye.2017.43 - DOI - PMC - PubMed
    1. Finsterer J. Ptosis: causes, presentation, and management. Aesthetic Plast Surg. 2003;27(3):193–204. doi: 10.1007/s00266-003-0127-5 - DOI - PubMed