Topical naphazoline in treatment of myopathic ptosis

Abstract

We instilled naphazoline Hcl (0.1%), an imidazole derivative with preferential alpha-2 activity, in 17 eyes of 12 patients with myopathic ptosis due to involvement of the levator palpebrae superioris, in the attempt to selectively stimulate Müller's smooth muscle. Naphazoline significantly widened the palpebral fissure with little change in pupillary diameter and no significant change in ocular pressure, visual acuity and near point determination. However, a reduction of the effect, probably due to tachyphylaxis, was noticed when using naphazoline regularly several times a day for few weeks. In conclusion naphazoline has powerful cosmetical and functional effects in mild to moderate myopathic ptosis above all if taken occasionally.

Naphazoline as a Confounder in the Diagnosis of Carotid Artery Dissection

“…This effect was lost after regular daily use for a few weeks. 10 In the current patient, the chronic use of naphazoline very likely led to tachyphylaxis and loss of effect on Müller's muscle and the corresponding lower eyelid muscle. Given more time, the mydriadic effect of naphazoline may have diminished as well.…”

“…His development of ptosis at later visits, however, can be explained by tachyphylaxis. A study by Uncini et al 10 used naphazoline to treat myopathic ptosis and noted that it widened the palpebral fissure. This effect was lost after regular daily use for a few weeks.…”

The stigma of “mental” illness: End stage anorexia and treatment refusal

“…The eyelid elevator muscles include the levator palpebrae muscle for voluntary opening and Müller smooth muscle for tonic control 6, 9. The former receives cholinergic motor innervation (by the third cranial nerve), and the latter receives adrenergic sympathetic innervation from the superior cervical ganglion 6, 9. Antibodies against AChE (AChE‐Abs) are often present in MG and are more frequently detected in OMG than in GMG 9.…”

“…The Müller muscle contracts via α‐adrenergic receptors and is reported to respond dramatically to topical phenylephrine, a selective α 1 ‐agonist 6. However, phenylephrine has the drawback of producing mydriasis and associated glare due to stimulation of the iris dilator muscle 6.…”

“…An eyewash containing naphazoline, a sympathomimetic drug with preferential α 2 activity, is reported to selectively increase the tone of the Müller muscle, widen the palpebral fissure, and have cosmetic and functional effects for mild to moderate myopathic ptosis or partial Horner syndrome 5, 6. In this study, we examined the efficacy of topical naphazoline in the treatment of myasthenic blepharoptosis in a multicenter open trial.…”