Apraclonidine in the unlicensed treatment of eyelid ptosis

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.