Quantitative Depth of Upper Eyelid Sulcus Deepening with Prostaglandin Analog Therapy
The available evidence does not provide specific millimeter measurements for the depth of upper eyelid sulcus deepening (DUES) caused by prostaglandin analog (PGA) therapy. The published studies focus on incidence rates and qualitative assessments rather than quantitative depth measurements.
Key Findings on DUES Incidence
The research literature documents DUES as a recognized adverse effect of PGA therapy, but measurements are limited to photographic comparisons rather than precise depth quantification:
Incidence Rates by PGA Type
Bimatoprost shows the highest incidence of DUES among all prostaglandin analogs:
- Bimatoprost: 60% objective incidence at 6 months when switching from latanoprost, with 44% showing DUES at just 1 month 1, 2
- Travoprost: 50% objective incidence 2
- Latanoprost: 6% objective incidence at 6 months (3/52 patients), with only 2% at 2 months 3, 2
- Tafluprost: 14% objective incidence at 6 months 4, 2
- Unoprostone: 8% objective incidence 2
Assessment Methodology Limitations
The current evidence base relies on qualitative photographic assessment rather than quantitative measurements 4, 3, 1, 2. Three independent ophthalmologists typically evaluate serial photographs by comparing treated versus untreated eyes or baseline versus follow-up images, reaching consensus on presence or absence of DUES rather than measuring depth in millimeters.
Clinical Risk Factors
Older age and longer duration of PGA use significantly correlate with DUES development 5. Non-myopic eyes also show higher susceptibility 1. Korean patients demonstrated 53.4% overall periorbital changes with PGAs, with superior sulcus deepening being the most common manifestation at 24.1% 5.
Clinical Implications
The lack of quantitative depth data represents a significant gap in the literature. Clinicians should inform patients about DUES as a potential cosmetic side effect before initiating PGA therapy, particularly with bimatoprost 4, 2. However, the inability to predict or measure the degree of deepening in millimeters limits precise patient counseling about expected cosmetic changes.
Patient self-recognition of DUES is poor, with only 53.3% of objectively confirmed cases being noticed by patients themselves 1. This discrepancy suggests that photographic documentation at baseline and follow-up visits may be warranted for medicolegal purposes and patient education, even though precise depth measurements remain unavailable.