Periorbital skin hypopigmentation associated with the use of topical glaucoma medications

Topical medications such as prostaglandin analogues, beta-blockers, alpha-2 agonists, and carbonic anhydrase inhibitors are routinely used for the management of ocular hypertension and glaucoma. Many are associated with adverse effects. We present the case of a 72-year-old woman who developed bilateral periocular hypopigmentation in the setting of long-term use of latanoprost, timolol, and brinzolamide/brimonidine. A well-known side effect of prostaglandin analogues is skin hyperpigmentation, but a few cases of a paradoxical hypopigmentation have been reported. Timolol and brinzolamide/brimonidine have not been associated with changes in skin pigmentation in the ophthalmic literature. Our case most likely represents a rare instance of paradoxical skin depigmentation associated with latanoprost use and adds to the limited literature on this clinical entity.