Predictors of severity in prostaglandin-associated periorbitopathy

To determine the predictive factors for severity in prostaglandin-associated periorbitopathy (PAP) using an objective grading system.

The study included patients diagnosed with glaucoma or ocular hypertension who had used a topical prostaglandin analog (PGA) unilaterally for at least three months. Clinical characteristics and PAP signs were compared based on the types of PGAs used. The severity of PAP signs was categorised according to an objective grading system. Univariate and multivariate logistic regression analyses were performed to identify risk factors for different grades of PAP.

Among the 86 patients included in the study, 24 (27.9%) used bimatoprost, 35 (40.7%) used latanoprost, and 27 (31.4%) used travoprost. The most commonly observed feature of PAP was orbital fat atrophy (48.8%), followed by deepening of the upper eyelid sulcus (38.4%), involution of dermatochalasis (32.6%), and enophthalmos (26.7%). Fifty-eight patients (67.4%) exhibited at least one periorbital change associated with PGA use. Multivariate logistic regression analysis revealed that age >60 years (p < 0.05), the use of bimatoprost (p < 0.05) and travoprost (p < 0.05), and PGA therapy duration >1 year (p < 0.05) were independent risk factors for higher grades of PAP.

Older age, longer duration of PGA therapy, and the use of bimatoprost and travoprost were significant and independent predictors of severe PAP in patients with glaucoma. Patients with these risk factors should be identified and managed to prevent the development of severe PAP.