Topical Ophthalmic Oxymetazoline: A Promising Treatment Option for Ocular Synkinesis

Objective: To evaluate objective and subjective outcomes in patients with ocular synkinesis before and 1 month after daily ophthalmic oxymetazoline, using standardized photographs, the Sunnybrook Facial Grading Scale, and patient-reported measures. Background: Ophthalmic oxymetazoline, an alpha-adrenergic agonist Food and Drug Administration approved for acquired blepharoptosis, stimulates eyelid retractors but has not been studied for ocular synkinesis. Method: Adult outpatients with ocular synkinesis self-administered 0.1% oxymetazoline in the clinic and daily for 30 days. Assessments included standardized photos, synkinesis-specific questionnaires, and paired Mann-Whitney U tests for pre-/post-treatment comparisons. Results: Twenty-eight patients (median age = 58, 79% female) were included. Patient race was identified through the electronic medical record, with 4 patients identified as Black, 23 identified as White, and 1 identified as "Other." Etiologies of facial paralysis included Bell's palsy (n = 16), iatrogenic (n = 10), and herpes zoster (n = 2). One-hour post-administration, mean Sunnybrook synkinesis scores decreased (7.8 vs. 6.2, p < 0.001). Palpebral fissure height during maximal synkinesis increased by 24.7% (standard deviation = 27, p < 0.001). Oral-ocular synkinesis scores decreased by 22% (p < 0.001). Among 25 respondents, 20 would continue to use it if covered by insurance, and 19 would recommend it. Conclusion: Ophthalmic oxymetazoline is a daily, noninvasive, well-tolerated treatment that reduces symptoms of ocular synkinesis-related blepharospasm.