What You Should Know About Upneeq Side Effects Before You Start

Upneeq (Oxymetazoline Hydrochloride ophthalmic solution, 0.1%) is the only FDA-approved eye drop for acquired blepharoptosis — droopy upper eyelids in adults. Like any medication, it comes with potential side effects. The good news? Most are mild and go away on their own. But it's important to know what to watch for so you can act quickly if something feels off.

This guide covers the common side effects, the serious ones that need immediate attention, and practical tips for managing symptoms.

What Is Upneeq? A Quick Overview

Upneeq is a prescription eye drop made by RVL Pharmaceuticals. It works by stimulating Müller's muscle in the upper eyelid, causing it to contract and lift the eyelid. You apply one drop to the affected eye(s) once daily. For a deeper look at how the medication works, see our article on how Upneeq works.

Common Side Effects

In clinical trials, the following side effects were reported in 1–5% of patients using Upneeq. These are generally mild and tend to resolve on their own:

• Punctate keratitis — tiny scratches on the surface of the cornea that may cause a gritty or stinging sensation
• Conjunctival hyperemia (eye redness) — mild redness in the white part of the eye
• Dry eye — a feeling of dryness, grittiness, or irritation
• Blurred vision — temporary blurriness right after applying the drop
• Instillation site pain — brief stinging or discomfort when the drop hits your eye
• Eye irritation — general discomfort in or around the eye
• Headache — mild headache that usually resolves within hours

Most patients who experience these side effects find that they lessen with continued use over the first few days.

Serious Side Effects

Serious side effects with Upneeq are rare, but they do require immediate medical attention. Contact your doctor or go to the emergency room if you experience any of the following:

• Allergic reaction: Hives, difficulty breathing, swelling of the face, lips, tongue, or throat. This is a medical emergency.
• Ongoing or worsening eye redness: Redness that doesn't go away or gets worse over time could signal an underlying problem.
• Eye pain: Sharp or persistent pain in the eye (not just brief stinging from the drop).
• Changes in vision: Any sudden loss of vision, seeing halos, or significant visual changes.
• Fast or irregular heartbeat: Because Oxymetazoline is an alpha-adrenergic agonist, it can occasionally affect heart rate.
• Sudden dizziness or lightheadedness: This could indicate a blood pressure change.
• Symptoms of acute angle-closure glaucoma: Severe eye pain, headache, nausea, and blurred vision. This is rare but is a medical emergency.

Side Effects in Specific Populations

Contact Lens Wearers

Remove contact lenses before applying Upneeq and wait at least 15 minutes before reinserting them. The preservatives and formulation can interact with soft contact lenses.

Pregnant or Breastfeeding Women

It's not known whether Upneeq can harm a fetus or pass into breast milk. If you're pregnant, planning to become pregnant, or breastfeeding, talk to your doctor before using Upneeq.

Children

Upneeq has not been studied in children under 13. It is not recommended for pediatric use.

People with Cardiovascular Conditions

Use Upneeq with caution if you have severe or unstable cardiovascular disease, uncontrolled high or low blood pressure, or cerebral or coronary insufficiency. The active ingredient can have mild systemic effects on blood pressure and heart rate. Make sure your prescribing doctor knows about any heart conditions. See our article on Upneeq drug interactions for more details.

People with Certain Eye Conditions

If you have untreated narrow-angle glaucoma or Sjögren's syndrome, use Upneeq with caution. The medication could worsen angle-closure glaucoma in susceptible individuals.

How to Manage Common Side Effects

If you're dealing with mild side effects, these tips can help:

• For dry eye or irritation: Use preservative-free artificial tears 15 minutes before or after applying Upneeq. Don't use other eye drops at the same time.
• For blurred vision: Wait a few minutes after applying the drop before driving or doing close work. Blurriness usually clears within minutes.
• For stinging on application: Make sure the drop lands in the eye — not on the eyelid or lashes. A clean application reduces irritation. Also, make sure your hands are clean and you're not touching the tip of the vial to your eye.
• For headache: An over-the-counter pain reliever like Acetaminophen usually helps. If headaches persist, tell your doctor.
• For redness: Mild redness typically fades within 30 minutes. If it lasts longer or worsens, contact your provider.

When to Call Your Doctor

Call your doctor if:

• Any side effect is getting worse instead of better
• You develop new symptoms that started after beginning Upneeq
• You have eye pain that lasts more than a few minutes
• Your vision changes in any way
• You feel dizzy, lightheaded, or notice your heart racing

When in doubt, call. It's always better to check than to wait it out.

Final Thoughts

Upneeq has a generally favorable side effect profile. The most common issues — dry eye, mild redness, and brief stinging — are manageable and often improve with time. Serious side effects are rare but worth knowing about so you can respond quickly.

If you're considering Upneeq, talk to your doctor about your full medical history, especially if you have heart conditions, glaucoma, or are taking medications that could interact. For more on what Upneeq is and how to use it, check out our complete guide: What Is Upneeq? Uses, Dosage, and What You Need to Know.

Need help finding Upneeq in stock? Search Medfinder to check availability at pharmacies near you.