Bleb Reformation After Lateral Cantholysis in a Case of Prostaglandin-associated Periorbitopathy

An 84-year-old male with uncontrolled intraocular pressure (IOP), despite maximum topical medications including prostaglandin F2α analog, had bilateral prostaglandin-associated periorbitopathy-related tight upper eyelids. One day after trabeculectomy of the left eyelid, IOP was 24 mm Hg, with a flat bleb. Daily ocular massage failed to maintain bleb filtration. IOP was reduced to 4 mm Hg after lifting the left upper eyelid; hence, ocular compression from a tight upper eyelid was the suspected cause preventing flow from the scleral flap. A lateral cantholysis was performed to release the eyelid pressure. On the first postoperative day, the bleb was documented to be large and diffuse, with subsequent IOP reduction to 10 mm Hg. At the third month of follow-up, the IOP was 8 mm Hg in the left eyelid, with a well-formed bleb.