Eyelid Position and Patient-Reported Aesthetic Outcomes Following Administration of Topical Oxymetazoline: A Prospective Cohort Investigation

September 2025 | Volume 24 | Issue 9 | 9061 | Copyright © September 2025


Published online August 26, 2025

doi:10.36849/JDD.9061

Alisha Kamboj MD MBAa, Mona M. Selim MDb, Brian D. Zelickson MDb, Andrew R. Harrison MDa,c

aDepartment of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN
bSchweiger Dermatology Group, Edina, MN
cDepartment of Otolaryngology and Head and Neck Surgery, University of Minnesota, Minneapolis, MN

Abstract
Background: Topical oxymetazoline hydrochloride 0.1% is a pharmacologic agent for eyelid elevation.
Objective: This study investigates changes in eyelid position and patient-reported aesthetic outcomes following topical oxymetazoline.
Methods and Materials: A prospective cohort investigation was conducted at a single institution. Participants received one drop of oxymetazoline in each eye. Margin reflex distance-1 and palpebral fissure height were recorded pre- and 15 minutes post-instillation. FACE-Q validated surveys regarding patient-reported upper eyelid appraisal and perceived age were administered pre- and post-intervention and a survey regarding outcome satisfaction was administered post-intervention.
Results: One hundred participants were enrolled. The mean age was 52.0 years. Participants predominantly self-identified as female (90%) and white (94%). Following oxymetazoline administration, there were statistically significant increases in margin reflex distance-1 (mean increase 0.8 mm, P<0.001) and palpebral fissure height (mean increase 0.8 mm, P<0.001). Significantly, upper eyelid appraisal improved by 23.5% (P<0.001) and perceived age decreased by 1.4 years (P<0.003) after oxymetazoline instillation. Overall, 85% of participants reported 51% or higher outcome satisfaction. There were no reported treatment-associated adverse events.
Conclusions: Administration of topical oxymetazoline was associated with statistically significant improvements in eyelid position, upper eyelid appraisal, and perceived age. The majority of participants reported outcome satisfaction.

J Drugs Dermatol. 2025;24(9): doi:10.36849/JDD.9061

INTRODUCTION

Eyelid rejuvenation represents an increasingly important topic in the realms of aesthetic and functional medicine. According to a report by the International Society of Aesthetic Plastic Surgery, eyelid surgery comprised the third most common plastic surgery performed worldwide and in the United States in 2021.1 Similarly, according to the American Society of Plastic Surgeons, blepharoplasty has ranked among the top 5 most common cosmetic surgeries for over a decade.2

Eyelid surgery is frequently performed to address blepharoptosis, or abnormal drooping of the upper eyelid margin. As blepharoptosis has been shown to affect both visual function and quality of life, including levels of anxiety, depression, and appearance-related distress, adequate management has the potential to improve patient aesthetics, visual function, mental health, and quality of life.3–6 While surgical intervention, often targeting the upper eyelid retractor muscles, represents the current mainstay of therapy to address eyelid position, it carries multiple risks, including bleeding, infection, scarring, lagophthalmos, and the need for reoperation.

In recent years, topical oxymetazoline, an alpha-adrenergic agonist that stimulates alpha-1 and alpha-2 receptors, has been studied as a pharmacologic agent for eyelid elevation. By targeting a subset of adrenoreceptors found in the Müller’s muscle of the upper eyelid, this agent has shown promise in the pharmacologic management of patients with blepharoptosis.7 Two randomized controlled trials have reported improvements in objective measures, including change in peripheral field testing and margin to reflex distance 1 (MRD1) assessment, following oxymetazoline administration.8 By targeting alpha-2 receptors, this agent may play a role in ocular surface vasoconstriction and improve eye redness. A recent randomized trial reported improvements in participant perception of eye redness following oxymetazoline administration.9

While prior studies have reported information regarding eyelid function and eye appearance, this study aims to further investigate and describe patient-reported aesthetic outcomes following administration of topical oxymetazoline hydrochloride 0.1%, to guide clinicians in providing patient-centered care.

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