Commentary on: Do Prostaglandin Analogue Lash Lengtheners Cause Eyelid Fat and Volume Loss?

See the Original Article here.

The article “Do Prostaglandin Analogue Lash Lengtheners Cause Eyelid Fat and Volume Loss?” ¹ is a cleverly conceived study that examines before-and-after color photos taken from official product websites promoting both prescription and over-the-counter prostaglandin analogue lash-lengthening products. The authors sought to determine if any evidence exists that such products can lead to “prostaglandin-associated periorbitopathy” (PAP).^2-4 PAP, first recognized in users of the prostaglandin analogue glaucoma eye drop (bimatoprost and others), consists of orbital fat loss, enophthalmos, deepening of the superior sulcus, elevated eyelid crease, ptosis, exaggerated dermatochalasis, darkening of the skin, and lower eyelid retraction.

Interest in prostaglandin analogues for cosmetic purposes arose after ophthalmologists observed remarkable lash lengthening and darkening in patients treated with these topical medications. In 2008, Latisse (Allergan Inc., Irvine, CA) was introduced as a 0.03% solution approved for utilization once per day on the upper eyelid lashes. Within the next few years, multiple over-the-counter products were also introduced. Given the massive size of the worldwide cosmetic market, it is not surprising to see the proliferation of these preparations.

The authors found convincing evidence that topically applied lash-lengthening products may lead to the changes of PAP as judged by 3 ophthalmologists and 2 laypeople who examined before-and-after images taken from official product websites. The authors tried to standardize the photo bank as much as possible under the circumstances. They developed a novel and simple grading system to judge the severity of PAP. The authors freely discuss the limitations of their study, namely the small numbers of images utilized and the possibility that some of the photos could have been manipulated on the websites. Additionally, they do not discount the possibility that normal aging changes could contribute to some of the observed effects.

The authors come to the obvious conclusion that an appropriate patient study is needed to determine the actual existence, frequency, and severity of PAP in users of lash-lengthening products. They further point out the great difficulty that consumers have in determining the exact content of over-the-counter preparations given the minimal oversite of this market.

Discontinuation of topical prostaglandin-containing eye drops employed in treatment of glaucoma usually results in diminution of the signs of PAP, although not many patients have this an option due to the nature of the disease. Cessation of topical lash lengtheners also results in a slow return to the pretreatment appearance of the lashes. One would expect a similar diminution in the signs of any lash-lengthening–induced PAP if it is indeed a real phenomenon.

A polling of my glaucoma associates in our large academic ophthalmology practice indicates that they all appraise patients of the potential development of PAP on continued utilization of prostaglandin analogue medications. Other side effects of such medications include macular edema, intraocular inflammation, and darkening of the iris. Darkening of the iris, when it occurs, is permanent and can be quite upsetting to patients with blue eyes.

Personally, I have not observed signs of PAP in my patients utilizing prostaglandin-based lash lengtheners. I must admit, however, that I have not specifically looked for this syndrome and therefore may have missed it. Under the circumstances, it seems prudent to recommend the following:

1. It is wise for those of us who prescribe topical lash-lengthening products to be aware of the potential of PAP.

2. Surgeons should keep this syndrome in mind when evaluating patients for aesthetic eyelid surgery because most patients will not offer that they utilize such products unless specifically asked. I know that some of my patients apply the products not only to their eyelashes but also the eyebrows, thus increasing the potential of side effects.

3. If there is any suspicion that topical prostaglandin analogues are contributing to the findings on examination, the patients may need to stop them for several months and then be reexamined.

Disclosures

Dr Wojno declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes