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PHOTO ESSAY |
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Year : 2016 | Volume
: 64
| Issue : 6 | Page : 459 |
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Prostaglandin-associated periorbitopathy
Neha Shrirao1, Mona Khurana2, Bipasha Mukherjee1
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 Submission | 21-Nov-2015 |
Date of Acceptance | 24-Apr-2016 |
Date of Web Publication | 3-Aug-2016 |
Correspondence Address: Neha Shrirao Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, 18, College Road, Chennai - 600 006, Tamil Nadu India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0301-4738.187676
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 |
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 | | |
1. | Peplinski LS, Albiani Smith K. Deepening of lid sulcus from topical bimatoprost therapy. Optom Vis Sci 2004;81:574-7. [ 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. |
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. [ 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. [ 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. [ PUBMED] |
[Figure 1]
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