Apraclonidine may alleviate ptosis associated with myasthenia gravis (MG), according to a new study published in the journal Muscle and Nerve. It may, therefore be an effective alternative for patients with these conditions.

The effect of apraclonidine was tested in a phase 2 clinical trial in 10 participants with ptosis secondary to MG. Participants were treated with 2 drops of 0.5% apraclonidine solution applied to the most affected eye. 

The investigators, led by Johnny Salameh, MD, from the Department of Neurology, American University of Beirut Medical Center, Lebanon, assessed the palpebral fissure height, marginal reflex distance 1 and 2, and levator function before and 1, 5, 30, and 60 minutes after the administration of apraclonidine.

They reported improvement in all eyelid measurements in all participants as early as 1 minute following treatment. 

The average palpebral fissure height increased from a median of 8.8 mm  to a median of 14.2 mm 1 hour after treatment. Similarly, the marginal reflex distance 1 and 2 both increased following the administration of apraclonidine from a median of 1.7  and 7.1 to a median of 5.4 and 8.8, respectively . Finally, levator function increased from a median of 13.4 mm at baseline to a median of 17.5 mm 60 minutes later. The researchers reported that all increases were statistically significant.

Read more about the symptoms of MG

Apraclonidine is an adrenergic receptor agonist that is used for the short-term treatment of glaucoma. By acting on Muller’s muscles, it elevates the eyelid and can effectively treat ptosis.

MG is a rare neuromuscular disease affecting the neuromuscular junction in skeletal muscle leading to fatiguability and muscle weakness. 

Weakness affecting the eyes is often the first sign of the disease with most patients developing ocular manifestations including ptosis at some point during their illness. Around 22% of patients with MG may have isolated ocular disease.


Agha M, Ismail H, Sawaya R, Salameh J. Efficacy of apraclonidine eye drops in treating ptosis secondary to myasthenia gravis: A pilot clinical trial. Muscle Nerve. Published online May 31, 2023. doi:10.1002/mus.27851

Efficacy of apraclonidine eye drops in the treatment of ptosis secondary to myasthenia gravis. ClinicalTrials.gov. September 16, 2021. Accessed June 6, 2023.