Unilateral Prostaglandin-Associated Periorbitopathy: A Syndrome Involving Upper Eyelid Retraction Distinguishable From the Aging Sunken Eyelid.
OBJECTIVE
To study the effects of prostaglandin analogue drops on the eyelids and adnexa in unilaterally treated subjects with the intention of qualifying, quantifying, and categorizing the characteristics of prostaglandin-associated periorbitopathy (PAP).


METHODS
Patients using prostaglandin analogue drops in only 1 eye for at least 1 year were evaluated by masked examiners. Orbital and eyelid measurements were obtained for each patient, and adnexal photographs were taken. PAP was divided into 3 grades based on the presence and severity of fat atrophy and the existence and depth of superior sulcus deformity. Statistical analysis was performed comparing data between treated and untreated eyes.


RESULTS
Thirty-three patients meeting eligibility criteria were enrolled, with equal numbers of subjects using latanoprost, travoprost, and bimatoprost. Treated eyes had a statistically significant increase in lagophthalmos (0.62 mm, p < 0.001), superior sulcus deformity/PAP grade (0.72, p < 0.001), and eyelid redness (1.08, p < 0.001). Treated eyes had significantly greater marginal reflex distance 1 measurements (0.89 mm, p = 0.02), highest with bimatoprost and moderate PAP. Treated eyes had relatively greater enophthalmos than untreated eyes. Very few patients noticed or complained about eyelid changes.


CONCLUSIONS
Prostaglandin analogue drops cause adnexal changes and orbital fat atrophy leading to eyelid redness, superior sulcus deformity, higher eyelid crease, and enophthalmos. In contrast to previous studies showing ptosis in PAP, relative upper eyelid retraction was seen in most of our treated eyes. Our novel PAP grading scale may help objectify and categorize this syndrome. Awareness of these signs is critical, as the eyelids and eyes may be affected even in the absence of patient recognition.
*Oculoplastic and Orbital Surgery Department, †Glaucoma Department, Wills Eye Hospital, Philadelphia, PA, U.S.A; and ‡Wills Eye Hospital, Philadelphia, PA, U.S.A.
Michael P
MP
Rabinowitz
L Jay
LJ
Katz
Marlene R
MR
Moster
Jonathan S
JS
Myers
Michael J
MJ
Pro
George L
GL
Spaeth
Priya
P
Sharma
Mary A
MA
Stefanyszyn
D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D000069580:Bimatoprost / Q000009:adverse effects; D015841:Enophthalmos / Q000139:chemically induced* / Q000175:diagnosis; D005141:Eyelid Diseases / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D005901:Glaucoma / Q000188:drug therapy; D006801:Humans; D000077338:Latanoprost; D008297:Male; D009798:Ocular Hypertension / Q000188:drug therapy; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000009:adverse effects; D011465:Prostaglandins, Synthetic / Q000009:adverse effects*; D015595:Skin Aging; D013577:Syndrome; D000069557:Travoprost / Q000009:adverse effects
D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D011465:Prostaglandins, Synthetic; D000077338:Latanoprost; D000069580:Bimatoprost; D000069557:Travoprost