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Deepening of the Upper Eyelid Sulcus Caused by 5 Types of Prostaglandin Analogs

Inoue, Kenji MD, PhD*; Shiokawa, Minako MD, PhD*; Wakakura, Masato MD, PhD*; Tomita, Goji MD, PhD

doi: 10.1097/IJG.0b013e31824d8d7c
Original Studies

Purpose: Upper eyelid sulcus deepening has recently been reported as an adverse effect of prostaglandin (PG) eye drop use. However, no data are available regarding the frequency of upper eyelid sulcus deepening caused by different types of PG eye drops. We used 5 types of PG eye drops in Japanese subjects and examined the frequency of appearance of upper eyelid sulcus deepening in these subjects.

Patients and Methods: The study included 250 patients (250 eyes) diagnosed with primary open-angle glaucoma or ocular hypertension. Five healthy patients were included as controls. One eye of each patient was treated with one of the following PG eye drops for >3 months: latanoprost, travoprost, tafluprost, bimatoprost, and isopropyl unoprostone. A single-lens reflex camera was used to photograph the open eyelids. Three ophthalmologists independently judged the appearance of the deepened upper eyelid sulcus in the photographs of the 250 patients and 5 controls by comparing the right and left eyes. A subjective self-reported symptom questionnaire was also administered.

Results: Upper eyelid sulcus deepening was objectively (photograph) and subjectively (questionnaire) noted in 24.0% and 12.0%, 50.0% and 24.0%, 18.0% and 10.0%, 60.0% and 40.0%, and 8.0% and 10.0% of the patients in the latanoprost, travoprost, tafluprost, bimatoprost, and unoprostone groups, respectively. It occurred more frequently (objectively and subjectively) in the bimatoprost group than in the latanoprost, the tafluprost, and the unoprostone groups (P<0.001).

Conclusion: Upper eyelid sulcus deepening frequently occurred with bimatoprost usage, and this effect should be sufficiently elucidated before starting bimatoprost treatment.

*Inouye Eye Hospital, Chiyoda-ku

Second Department of Ophthalmology, Toho University School of Medicine, Tokyo, Japan

Disclosure: The authors declare no conflicts of interest.

Reprints: Kenji Inoue, MD, PhD, Inouye Eye Hospital, 4-3 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan (e-mail:

Received September 21, 2011

Accepted January 9, 2012

© 2013 by Lippincott Williams & Wilkins.