Unilateral Prostaglandin-Associated Periorbitopathy

Abstract

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.

Periorbital changes associated with prostaglandin analogs in Korean patients

“…Instead, we enrolled monocular PGA users, and strictly excluded patients who had a history of periorbital trauma or surgery, patients with thyroid orbitopathy and contact lens users. All of the patients were being treated unilaterally, and this is very important point to differentiate true PAP from individual variation or simple aging change, as commented in other studies [12, 24]. We believe that the patient’s untreated eye can sufficiently serve as a control.…”

“…Ptosis can develop in the elderly because of involutional changes; hence, the frequency of ptosis can be easily overestimated, especially when analyzing bilaterally treated cases. For this reason, some researchers insist that ptosis is not necessarily a sign of PAP, but rather an independent age-related finding [24]. In addition, dermatochalasis can be mistaken as ptosis, especially in photographs.…”

“…Noma and Kakizaki [16, 25] reported a case in which bilateral upper eyelid retraction was associated with the use of bimatoprost. Recently, Rabinowitz et al [24] investigated the signs of PAP in patients treated with PGA unilaterally, and they reported that upper eyelid retraction was found in 76% of patients (25 out of 33). They compared the marginal reflex distance 1 (MRD1) between the treated and the untreated eyes, and the average amount of retraction was 1.49 mm.…”

Use of hyaluronic acid gel filler to improve contact lens wear in patients with deep sunken superior sulcus

“…Deep sunken superior sulcus of the upper eyelid can result from aging, genetic, prostaglandin use, and prior aggressive upper blepharoplasty. 1 It is usually merely a cosmetic issue with the patient complaining of looking older and tired with skeletanized eye appearance. In its extreme form, however, it can lead to sunken superior sulcus syndrome and/or giant fornix syndrome.…”

“…Aging, genetics, prostaglandin use and prior aggressive blepharoplasty are among the many causes which can lead to deep superior sulcus of the upper eyelid with fat atrophy and resultant retraction of the upper eyelid skin, orbicularis muscle, and orbital septum. 1 This can lead to sunken superior sulcus syndrome with exposure keratopathy and lagophthalmos from suboptimal orbicularis function and effective skin shortening. 2 Giant fornix syndrome is a related condition with recalcitrant conjunctivitis in elderly patients with deep superior fornix with subsequent accumulation of mucopurulent secretions and persistent discharge.…”