A patient with glaucoma on travoprost (prostaglandin analogue) develops periorbital skin darkening, increased eyelash growth (hypertrichosis), and periorbital fat atrophy. These are classified as:
- A Signs of systemic prostaglandin toxicity
- B Allergic reaction to the benzalkonium chloride preservative
- C Effects of aqueous production suppression causing orbital fat redistribution
- D Prostaglandin-associated periorbitopathy (PAP) — class adverse effects of topical prostaglandin analogues ✓
Explanation
Prostaglandin-associated periorbitopathy (PAP) is a recognised periocular adverse effect of long-term topical prostaglandin analogue use. Features include periorbital skin darkening (hyperpigmentation), hypertrichosis (increased eyelash length/thickness/number), deepening of the upper eyelid sulcus (due to periorbital fat atrophy), upper eyelid ptosis, and enophthalmos. These effects are mediated by activation of prostaglandin FP receptors in melanocytes, hair follicles, and adipocytes. They are bilateral (symmetrical) if both eyes are treated, or unilateral (asymmetrical) — this can be diagnostically useful. The mechanism involves lipogenesis/lipolysis in periorbital fat. Benzalkonium chloride causes toxic/allergic conjunctivitis, not periorbital fat atrophy. These are topical drug effects, not systemic toxicity.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.