Severe Microbial Keratitis Secondary to Prostaglandin-Associated Periorbitopathy

Prostaglandin-associated periorbitopathy (PAP) is a known complication of prostaglandin therapy most commonly associated with topical bimatoprost. PAP is characterized by a progressive constellation of eyelid, periorbital, and conjunctival signs that contribute to cosmetic and functional challenges for patients and clinicians. This constellation of findings can produce an asymmetric appearance, symptomatic discomfort, and ocular surface changes to patients. In our case, these changes resulted in previously unreported sight-threatening sequelae from bacterial keratitis. The authors report a case of PAP-induced lagophthalmos and secondary microbial keratitis that necessitated a corneal graft. Reversal of these findings occurred on prostaglandin cessation with dramatic reversal of findings within 8 weeks.