Use of 0.5% apraclonidine solution in evaluation of blepharoptosis

To evaluate the effect of instillation of a specific alpha2-adrenergic agonist, topical 0.5% apraclonidine solution, on upper eyelid position in patients with blepharoptosis.

This study included 45 eyelids of 35 adult patients with blepharoptosis. Of these, 37 eyelids had acquired ptosis and 8 had congenital ptosis. Palpebral fissure height and margin-reflex distance in the upper eyelid were measured before and after instillation of 0.5% apraclonidine, 2.5% phenylephrine, and both drugs.

After instillation of 2.5% phenylephrine, 0.5% apraclonidine, and both drugs, the mean increases in palpebral fissure height were 2.12 mm+/-1.4 mm, 2.11 mm+/-1.4 mm, and 2.26 mm+/-1.3 mm, respectively, and the mean increases in margin-reflex distance were 1.93 mm+/-1.2 mm, 1.89 mm+/-1.3 mm, and 2.03 mm+/-1.2 mm, respectively (p=0.86 and p=0.85). The apraclonidine solution did not alter the test results in 14 eyelids in which the phenylephrine test results were negative.

Topical 0.5% apraclonidine solution can be as effective as topical 2.5% phenylephrine in elevating a ptotic upper eyelid, and may be used for preoperative evaluation of blepharoptosis. Combined use of both drugs may not provide any additional benefit.