Prostaglandins-associated Periorbital Lesions

PG drugs have been used in clinical practice since the 90s of the 20th century and introduced into China at the beginning of the 21st century. At present, PG drugs available in the domestic market include prostamine, travoprost, bemeprost and tafluprost. PG class drugs with its good ocular pressure lowering effect (ocular pressure lowering effect of 25%-33%, **** reduction up to 8-9mmHg), stable control of intraocular pressure fluctuations, especially night intraocular pressure fluctuations, easy to use (1 time a day), less systemic and local side effects, is recommended by the glaucoma group as the first-line treatment of open-angle glaucoma, and has been favored by more and more glaucoma doctors.
With the increase of clinical application of PG drugs, their local side effects gradually appeared. In recent years, prostaglandins-related periorbital lesions (PAPs) have gradually attracted the attention of scholars from all over the world. PAP is a type of syndrome with clinical manifestations including lax and droopy skin of the upper eyelid, deepening of the upper eyelid sulcus, orbital lipoatrophy, orbital depression, and clicks on closed eyes. The specific mechanism of its occurrence is not yet clear. It is tended to think that PG drugs inhibit adipocyte differentiation, resulting in orbital lipoatrophy; Some scholars have also proposed that PG drugs affect Muller's muscle function, but more research is needed.
Due to the difference in molecular structure and the difference in affinity with FP/EP receptor, the four PG drugs commonly used in clinical practice cause different degrees of periorbital lesions. Large clinical studies have shown that patients using bemeprost are more likely to develop PAP, followed by travoprost, **** prost and tafluprost. Studies have shown that after periorbital changes caused by the use of bemeiprost in glaucoma patients, the periorbital lesions of most patients can be reversed by replacing them with prostastins. This suggests that the change of PAP is not ***, it can be reversed, and its severity can be alleviated clinically by changing and stopping the drug. If the patient uses PG drugs to lower blood pressure, but has more severe periorbital lesions, and the patient himself has higher requirements for ocular aesthetics, it can be replaced with tafluprost or prostalin.
In clinical work, it is also necessary to combine the needs of patients themselves and the consideration of doctors, and adopt different treatment methods for different patients to achieve satisfactory treatment results.
Since its launch, tafluprost has been recognized by glaucoma doctors. Its main advantage is the low incidence of side effects such as conjunctival hyperemia and periorbital lesions; It can increase the blood perfusion of the papilla, which is of great significance for patients with advanced glaucoma; The antihypertensive effect and reactivity in NTG patients are better than other PG drugs; Single-dose packaging without preservatives has been marketed abroad, which is a good gospel for glaucoma patients who need long-term medication. It is believed that with the accumulation of clinicians' medication experience, its superiority will be further reflected.