travoprost and Hyperpigmentation

A 54-year-old Indian male with a diagnosis of ocular hypertension was started on a prostaglandin analog (PGA) in both eyes to lower intraocular pressure. Six years later, he developed progressively increasing bilateral limbal conjunctival hyperpigmentation. Travoprost was discontinued and replaced with brinzolamide and over the next year, the patient's conjunctival pigmentation improved significantly in both the eyes. This case report documents with slit-lamp photography the first case of conjunctival pigmentation associated with PGA use that has been shown to have reversal with discontinuation of the PGA. Because of the widespread use of PGAs, and the evolving nature of the conjunctival pigmentation, clinicians should be aware of this reversible condition when considering biopsy or removal of conjunctival melanocytic lesions.

Topics: Antihypertensive Agents; Carbonic Anhydrase Inhibitors; Conjunctival Diseases; Drug Substitution; Humans; Hyperpigmentation; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Sulfonamides; Thiazines; Tonometry, Ocular; Travoprost

Topical travoprost, a prostaglandin F(2alpha) (PGF(2alpha)) analog, has several well-known side effects, including a darkening of the eyelid and eyelash hypertrichosis, but there are no reports of a deepening of the eyelid superior sulcus associated with its use.. We examined one patient with unilateral normal-tension glaucoma and another with unilateral primary open-angle glaucoma, both of whom were treated with travoprost monotherapy unilaterally for 2 years.. Both patients gradually developed a deepening of the eyelid superior sulcus with hyperpigmentation in the eyelid skin of the treated eye. The disparity between the treated eye and the fellow eye was quite visible. However, the disparity returned to normal after discontinuation of travoprost for 15 months. A deepening of the eyelid superior sulcus is more significant in Asians, who seldom have an eyelid crease or deep sulcus. One proposed mechanism is a mechanical insult to the eyelid causing levator dehiscence. A second possible mechanism is fatty degeneration and reduced collagen fibers in the levator complex caused by the PGF(2alpha) analog. However, the exact mechanism remains to be determined.. A deepening of the eyelid superior sulcus should be considered a possible complication of topical travoprost that can be reversed by discontinuation of the medication.

Topics: Aged; Antihypertensive Agents; Cloprostenol; Eyelashes; Eyelid Diseases; Female; Glaucoma, Open-Angle; Hair Diseases; Humans; Hyperpigmentation; Intraocular Pressure; Male; Travoprost