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Prostaglandin-Associated Periorbitopathy in Children and Young Adults with Glaucoma

Jane S Kim1, Sonya Blizzard1, Julie A Woodward1

  • 1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.

Ophthalmology. Glaucoma
|October 3, 2020
PubMed

Insights

Long-term unilateral prostaglandin analogue (PGA) use in children with glaucoma can cause mild to moderate eyelid and eye changes, known as prostaglandin-associated periorbitopathy (PAP). Patients should be informed about these potential side effects, especially with monocular therapy.

Area of Science:

  • Ophthalmology
  • Pediatric Glaucoma
  • Ocular Adnexa

Background:

  • Prostaglandin analogues (PGAs) are commonly used to treat glaucoma.
  • Unilateral PGA treatment can lead to asymmetry in ocular and periocular features.
  • Childhood glaucoma requires long-term management, often involving unilateral PGA therapy.

Purpose of the Study:

  • To evaluate palpebral and orbital changes from long-term unilateral prostaglandin analogue (PGA) exposure in pediatric glaucoma patients.
  • To identify specific features of prostaglandin-associated periorbitopathy (PAP) in this cohort.
  • To assess the reliability of expert graders in identifying PGA-treated eyes.

Main Methods:

  • Prospective cross-sectional cohort study of 29 patients with childhood glaucoma on unilateral PGAs for ≥12 months.
  • Standardized clinical photographs were assessed by 3 masked expert graders.
  • Graders identified PGA-treated eyes and graded ocular, palpebral, and periorbital features, with interrater reliability assessed using Fleiss kappa.

Main Results:

  • Long-term unilateral PGA use (median 31.7 months) resulted in features of prostaglandin-associated periorbitopathy (PAP).
  • Most frequent changes included eyelash trichomegaly/hypertrichosis (76%), high upper eyelid crease (69%), upper eyelid ptosis (52%), and superior sulcus hollowing (52%).
  • Changes were mostly mild, though 20-30% showed moderate eyelid/eyelash alterations; interrater reliability was excellent (κ=0.815).

Conclusions:

  • Mild-to-moderate prostaglandin-associated periorbitopathy (PAP) can occur in children and young adults with long-term unilateral PGA exposure.
  • Educating patients and families about potential PAP is crucial, particularly when initiating monocular PGA therapy.
  • These findings highlight the importance of monitoring for and understanding the cosmetic and functional implications of long-term PGA use in pediatric glaucoma.
Abstract

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