Oculoplastic considerations in patients with glaucoma

The incidence of glaucoma worldwide is increasing. Often, these patients may also be referred to oculoplastic surgeons for either age-related problems or issues secondary to medical or surgical glaucoma treatment. Eyelid malpositions (ptosis or lid retraction) may occur after glaucoma filtration surgery or the use of prostaglandin analogues. We review the incidence and mechanisms of lid malpositions found in the literature. Surgical correction for these malpositions also requires careful consideration and should be tailored to the individual patient to avoid undesirable surgical outcomes. For instance, overcorrection of ptosis may result in bleb exposure and the risk of blebitis or endophthalmitis. As use of topical prostaglandin analogues increases, we summarize the reports of prostaglandin analogue-associated periocular changes and its underlying etiologic mechanisms. Cessation of these medications may be required in some patients. Where topical treatment is to be continued, eyelid surgery has to be individualized and approached conservatively. It is imperative that patients with glaucoma and oculoplastic concerns be considered as a distinct entity to avoid unfavorable outcomes.