Alternatives to Upneeq: What Are Your Options?

Upneeq (Oxymetazoline Hydrochloride ophthalmic solution, 0.1%) is the only FDA-approved prescription eye drop for acquired blepharoptosis — drooping upper eyelids in adults. It works well for many patients, but what do you do if you can't find it at your pharmacy, can't afford the $225 to $350 monthly cash price, or if it's not the right fit for you?

In this article, we'll explain how Upneeq works and then walk through realistic alternatives for treating drooping eyelids in 2026. Keep in mind that you should always discuss treatment changes with your doctor before switching medications or therapies.

What Is Upneeq and How Does It Work?

Upneeq contains Oxymetazoline, an alpha-adrenergic agonist. When applied as an eye drop, it stimulates Müller's muscle — a smooth muscle in the upper eyelid — causing it to contract and lift the drooping lid. Most patients see a 1 to 2 millimeter improvement, which may sound small but can meaningfully improve both appearance and peripheral vision.

Upneeq is applied once daily, works within about 5 to 15 minutes, and the effect lasts for approximately 6 to 8 hours. It was approved by the FDA in July 2020 and is manufactured by RVL Pharmaceuticals. For a more detailed breakdown, read our article on how Upneeq works.

Why You Might Need an Alternative

There are several reasons you might be looking for an alternative to Upneeq:

• Availability: Upneeq has a limited distribution model and isn't stocked at most retail pharmacies. See our guide on why Upneeq is hard to find.
• Cost: Without insurance, a monthly supply costs $225 to $350, and many insurance plans don't cover it.
• Side effects: Some patients experience eye redness, dry eye, or irritation that makes continued use uncomfortable.
• Contraindications: Patients with certain cardiovascular conditions, narrow-angle glaucoma, or those taking MAOIs may not be good candidates.

Alternative #1: Surgical Ptosis Repair (Blepharoplasty)

For patients with moderate to severe ptosis — especially when it significantly affects vision — surgical repair is often the most effective long-term solution. Ptosis surgery (often called blepharoplasty or levator repair) involves tightening or repositioning the muscle that lifts the eyelid.

Pros:

• Permanent results in most cases
• Often covered by insurance when ptosis causes visual field obstruction (documented by a visual field test)
• One-time procedure rather than daily treatment

Cons:

• Requires surgery with associated risks (infection, asymmetry, over-correction)
• Recovery time of 1 to 2 weeks
• May not be covered by insurance if classified as cosmetic
• Not suitable for patients who are poor surgical candidates

If you're considering surgery, an oculoplastic surgeon is the specialist best equipped to evaluate your case.

Alternative #2: Phenylephrine Eye Drops (Off-Label)

Phenylephrine is another alpha-adrenergic agonist available as over-the-counter eye drops (commonly found in products like Neosynephrine). While it is not FDA-approved for ptosis, some eye care providers use low-concentration Phenylephrine drops off-label to temporarily lift a drooping eyelid.

Pros:

• Available over the counter at a much lower cost (under $15)
• Similar mechanism of action to Upneeq
• Can provide temporary eyelid lift

Cons:

• Not FDA-approved for ptosis — no clinical trials specifically for this use
• May cause more eye irritation or rebound redness
• Dosing and concentration may not be optimized for eyelid use
• Should only be used under a doctor's guidance

Talk to your eye doctor before trying Phenylephrine as an Upneeq alternative. Do not self-treat without medical advice.

Alternative #3: Brimonidine Eye Drops (Off-Label)

Brimonidine (brand name Alphagan P) is an alpha-2 adrenergic agonist primarily used to treat glaucoma by reducing eye pressure. Some practitioners have noted a mild eyelid-lifting effect as a secondary benefit, and it has been used off-label for subtle ptosis improvement.

Pros:

• Already FDA-approved (for glaucoma), so its safety profile is well-established
• May provide a mild eyelid lift in some patients
• Available as a generic, making it more affordable (around $15 to $40 with discount cards)

Cons:

• Not FDA-approved for ptosis — eyelid-lifting effect is modest and inconsistent
• Can cause eye redness, burning, or drowsiness
• May not be as effective as Upneeq for meaningful ptosis correction

Alternative #4: Eyelid Crutches (Non-Drug Option)

Eyelid crutches, also called ptosis crutches, are small wire devices that attach to the inside of eyeglass frames. They physically hold the drooping eyelid open, providing an immediate and drug-free solution.

Pros:

• No medication needed — purely mechanical
• Adjustable and removable
• Covered by some insurance plans as a medical device
• Good for patients who cannot use eye drops due to contraindications

Cons:

• Requires glasses to use
• Can be uncomfortable and take time to adjust
• Cosmetically visible on the glasses frame
• Not suitable for all types of ptosis

An optician experienced with ptosis crutches can custom-fit them to your frames.

How to Decide Which Alternative Is Right for You

The best alternative depends on your specific situation:

• Mild ptosis + cost is the issue: Ask your doctor about off-label Phenylephrine or Brimonidine drops, and explore savings programs for Upneeq before switching.
• Moderate to severe ptosis affecting vision: Surgical ptosis repair may be the best long-term solution and could be covered by insurance.
• Can't use eye drops: Eyelid crutches provide a drug-free mechanical option.
• Can't find Upneeq: Before switching, try using Medfinder to locate a pharmacy that has it — or check out our tips for finding Upneeq in stock.

Final Thoughts

Upneeq is a first-of-its-kind treatment, and there's no direct FDA-approved substitute for it as an eye drop for ptosis. However, there are meaningful alternatives available depending on the severity of your condition, your budget, and your medical history.

Always talk to your doctor before making a change. And if the issue is simply finding Upneeq, try Medfinder or read our guide on how to find Upneeq in stock near you before assuming it's unavailable. For a full overview of Upneeq's uses, dosing, and side effects, visit What is Upneeq?