Aesthetic Medicine
Topical pharmacologic management of post-botulinum toxin-induced blepharoptosis: a narrative review of evidence and clinical applications
By Chaiyarin Milinjaroonpong and Pongsiri Koonngam.
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Aesthetic Medicine
By Chaiyarin Milinjaroonpong and Pongsiri Koonngam.
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Botulinum toxin type A (BoNT-A) is widely used for cosmetic and therapeutic purposes, yet post-injection blepharoptosis remains a distressing complication for both patients and clinicians. While spontaneous resolution typically occurs within weeks, pharmacologic management - particularly with topical agents - offers an evidence-based means to expedite recovery and alleviate symptoms. This review aims to summarize the pharmacologic management of post–BoNT-A–induced blepharoptosis, focusing on mechanisms, efficacy, safety, and practical clinical application.
Literature was identified through targeted database searches including PubMed, Scopus, and Google Scholar, focusing on oxymetazoline, apraclonidine, phenylephrine, brimonidine, and pyridostigmine. Each agent’s mechanism, receptor specificity, dosage, onset, duration, and safety profile are discussed.
Clinical outcomes from case reports, trials, and expert consensus are summarized, highlighting variable efficacy and limited high-quality evidence. Oxymetazoline 0.1% has the strongest evidence, demonstrating consistent improvement in upper eyelid elevation via -adrenergic receptor–mediated Müller’s muscle contraction. Apraclonidine 0.5% remains a commonly recommended option despite potential tachyphylaxis. Phenylephrine is effective but may cause systemic side effects and rebound hyperemia. Brimonidine and pyridostigmine have niche roles with less robust data. Topical pharmacologic agents are generally well tolerated; however, the literature underscores the need for randomized controlled trials to determine optimal selection, dosing, and long-term safety.
This review provides a practical reference for clinicians in aesthetic and ophthalmic practice, emphasizing evidence-based drug choice and application.
Published in Aesthetic Medicine. The abstract is shown as published and remains the work of its authors; read the full article at the source.
mattioli1885journals.com/index.php/aestheticmedicine/article/view/18373
Prognia lists this article for reference and education. It is not medical advice. Always read the original and follow current guidelines and local protocols before acting on it.
