Topical Ophthalmic Oxymetazoline: A Promising Treatment Option for Ocular Synkinesis

<b>Objective:</b> 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. <b>Background:</b> 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. <b>Method:</b> 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. <b>Results:</b> 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 (<i>n</i> = 16), iatrogenic (<i>n</i> = 10), and herpes zoster (<i>n</i> = 2). One-hour post-administration, mean Sunnybrook synkinesis scores decreased (7.8 vs. 6.2, <i>p</i> < 0.001). Palpebral fissure height during maximal synkinesis increased by 24.7% (standard deviation = 27, <i>p</i> < 0.001). Oral-ocular synkinesis scores decreased by 22% (<i>p</i> < 0.001). Among 25 respondents, 20 would continue to use it if covered by insurance, and 19 would recommend it. <b>Conclusion:</b> Ophthalmic oxymetazoline is a daily, noninvasive, well-tolerated treatment that reduces symptoms of ocular synkinesis-related blepharospasm.