References
Apraclonidine in the unlicensed treatment of eyelid ptosis
Abstract
Eyelid ptosis is a complication that may occur following injection of botulinum toxin type A. It generally presents within 3–7 days of treatment. A drooping or lowering of the eyelid may be severe to the point that it leads to restriction of vision, or it may be subtle, with just the feeling of a heavy lid or, more typically, difficulty in being able to apply eye make-up. There is currently no licensed treatment for eyelid ptosis. Apraclonidine hydrochloride, commonly known as Iopidine is an alpha-adrenergic receptor agonist and causes the contraction of the Muller's muscle, which may result in an eyelid lift of 1–3 mm. There are factors that may lead to an increased risk of this complication, and there are also ways in which to help prevent it from occurring. Thorough consultations should always be given and practitioners should always ensure that they have in-depth knowledge of facial anatomy and musculature and use good injection technique.
Apraclonidine hydrochloride is the generic drug in the commonly-known brand Iopidine (Medicines.org.uk, 2019). A derivative of clonidine, it is a sympathomimetic licensed for use in glaucoma therapy and lowers intraocular pressure by reducing aqueous humour formation. Available commercially in two strengths in a sterile isotonic solution for topical application to the eye (Medicines.org.uk, 2019), apraclonidine 0.5% is licensed for the lowering of intraocular pressure in patients with ocular hypertension or glaucoma, whereas apraclonidine 1% is intended for the prevention and control of post-operative spikes in intraocular pressure (Committee, 2019).
Apraclonidine is an a2 adrenergic receptor agonist and a weak a1 adrenergic receptor agonist (Committee, 2019).
It should be noted that the side-effects that are recorded under the use of apraclonidine are related to its licensed use for Glaucoma, rather than is use in the treatment of eyelid ptosis. This may mean that they are only present following long-term use, rather than the short-term use associated with the treatment of ptosis. However, it is always important to make patients aware that the product is unlicensed for use in eyelid ptosis.
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