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    Topical treatment warning for orbital soft tissue

    Dr. CusterSt. Louis—Oculoplastic surgeons need to be aware that orbitopathy arising from the use of topical prostaglandin analogues is a real disorder, said Philip L. Custer, MD.

    The treatment-induced orbital soft tissue changes develop in many patients on long-term topical prostaglandin analogue treatment, said Dr. Custer, professor of ophthalmology and visual sciences, Washington University School of Medicine, St Louis.

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    In most, these changes are subtle. However, they can manifest as a variety of cosmetic and functional orbital and eyelid disorders that may be indications for surgery, or can complicate the execution and outcome of other oculoplastic procedures.

    The deformities in some patients may be reversible after treatment is discontinued, and in the future, these unintended effects of prostaglandins may be harnessed for therapeutic purposes.

    “If you encounter a patient with prostaglandin orbitopathy, work with the prescribing physician to determine if the medication can be withheld, and then, if possible allow a period of observation before proceeding with surgery,” Dr. Custer said. “In the future, we may see new delivery methods to protect the orbit from prostaglandin analogue exposure, and we may also see designer prostaglandin analogues developed to treat a variety of esthetic and functional eyelid disorders.”

    The development of periorbital changes in patients using topical prostaglandin analogues was first reported in 2004, and then again 4 years later. Both studies involved small series of patients and did not appear in mainstream journals.

    These initial reports may have been viewed with skepticism, owing to disbelief that a topical treatment could have such profound effects.

    “Over the years, I am increasingly encountering patients with prostaglandin orbitopathy,” Dr. Custer said.

    He discussed findings from a review he undertook of 35 patients with prostaglandin orbitopathy. The information was recently published online [Ophthal Plast Reconstr Surg. 2015 Feb 25. Epub ahead of print].

    Next: "I wonder how many of these drops were being used . . . "

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