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PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 459

Prostaglandin-associated periorbitopathy


1 Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
2 Department of Glaucoma, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India

Date of Submission21-Nov-2015
Date of Acceptance24-Apr-2016
Date of Web Publication3-Aug-2016

Correspondence Address:
Neha Shrirao
Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, 18, College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.187676

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Keywords: Antiglaucoma medication, fat atrophy, periorbitopathy, prostaglandin analogs, ptosis


How to cite this article:
Shrirao N, Khurana M, Mukherjee B. Prostaglandin-associated periorbitopathy. Indian J Ophthalmol 2016;64:459

How to cite this URL:
Shrirao N, Khurana M, Mukherjee B. Prostaglandin-associated periorbitopathy. Indian J Ophthalmol [serial online] 2016 [cited 2020 Feb 28];64:459. Available from: http://www.ijo.in/text.asp?2016/64/6/459/187676

A 59-year-old gentleman with primary open-angle glaucoma was on topical bimatoprost 0.03% in the left eye since last 6 years. He presented with deepening of superior sulcus (arrow), periorbital fat atrophy, mild ptosis (a), and 2 mm of enophthalmos (b) in his left eye [Figure 1], which are typically seen in prostaglandin-associated periorbitopathy (PAP). Comparison with old photographs taken before topical bimatoprost use showed the absence of any asymmetry between the eyes.
Figure 1: (a) Presence of left eye upper eyelid ptosis with deep superior sulcus (arrow) compared to right eye. (b) "Worm's hole view" (Nafziger method) showing left eye mild enophthalmos

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PAP, first reported in 2004, is caused by prolonged use of topical prostaglandin (PG) analogs. [1] It has been reported with the use of bimatoprost, travoprost, tafluprost, and latanoprost. [2],[3],[4] The classical features are as seen in our patient. PAP can appear as early as a month after the use of bimatoprost and is caused by fat atrophy, inhibition of adipocyte production, and differentiation of orbital fat due to PGF receptor stimulation by PG analogs. [2],[5] Complex effects of PG analogs on levator muscle and Muller's muscle along with orbital fat are postulated to be responsible for ptosis. [2] PAP is reversed several months to years after discontinuation of the drug. [1],[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Peplinski LS, Albiani Smith K. Deepening of lid sulcus from topical bimatoprost therapy. Optom Vis Sci 2004;81:574-7.  Back to cited text no. 1
[PUBMED]    
2.
Kucukevcilioglu M, Bayer A, Uysal Y, Altinsoy HI. Prostaglandin associated periorbitopathy in patients using bimatoprost, latanoprost and travoprost. Clin Experiment Ophthalmol 2014;42:126-31.  Back to cited text no. 2
    
3.
Sakata R, Shirato S, Miyata K, Aihara M. Incidence of deepening of the upper eyelid sulcus in prostaglandin-associated periorbitopathy with a latanoprost ophthalmic solution. Eye (Lond) 2014;28:1446-51.  Back to cited text no. 3
[PUBMED]    
4.
Sakata R, Shirato S, Miyata K, Aihara M. Incidence of deepening of the upper eyelid sulcus on treatment with a tafluprost ophthalmic solution. Jpn J Ophthalmol 2014;58:212-7.  Back to cited text no. 4
[PUBMED]    
5.
Taketani Y, Yamagishi R, Fujishiro T, Igarashi M, Sakata R, Aihara M. Activation of the prostanoid FP receptor inhibits adipogenesis leading to deepening of the upper eyelid sulcus in prostaglandin-associated periorbitopathy. Invest Ophthalmol Vis Sci 2014;55:1269-76.  Back to cited text no. 5
[PUBMED]    


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