Overview
Bimatoprost, latanoprost and travoprost are prostaglandin analogue eye drops used for glaucoma and ocular hypertension, and bimatoprost is also sold for eyelash growth. The authors searched PubMed, Embase, Web of Science and the Cochrane Library from inception to August 2025 under a registered protocol (PROSPERO CRD420251107027) for studies measuring periorbital structural change with topical bimatoprost, then ran random-effects meta-analyses against latanoprost and travoprost.
Findings
- 45 studies, 7,106 participants (3,176 bimatoprost-exposed), included.
- Meta-analysis of 5 comparative studies (742 eyes) versus latanoprost.
- Deepening of the upper eyelid sulcus: risk ratio 2.92 (95% CI, 1.98-4.30) with bimatoprost versus latanoprost; GRADE certainty low.
- Periorbital fat loss: risk ratio 3.10 (95% CI, 1.07-8.99) with bimatoprost versus latanoprost; GRADE certainty very low.
- No significant difference between bimatoprost and travoprost for any periorbital outcome (GRADE certainty very low).
- Reversibility after stopping the drug was variable; upper eyelid sulcus deepening showed the greatest resistance to recovery.
- Risk of bias assessed with Joanna Briggs Institute tools.
What it means for a patient
- A patient using bimatoprost long-term for glaucoma, or for lash growth, has a higher measured risk of upper eyelid hollowing and orbital fat loss than a patient using latanoprost.
- Switching from bimatoprost to travoprost is not shown to lower this risk, since the two performed the same in this analysis.
- The eyelid hollowing does not reliably go away after stopping the drop, particularly in the upper lid.
- The authors rate the certainty of this evidence as low to very low, from mostly observational studies.
Why this paper matters
It quantifies, across 45 pooled studies, how much more periorbital fat atrophy risk bimatoprost carries than latanoprost, and finds bimatoprost and travoprost carry the same risk.
Terms
- Prostaglandin analogue: a class of eye drop (bimatoprost, latanoprost, travoprost) that lowers eye pressure in glaucoma.
- Periorbital fat atrophy: loss of the fat around the eye socket, producing a hollow look.
- Upper eyelid sulcus: the groove between the upper eyelid and the brow bone.
- Enophthalmos: the eye sitting more deeply in the socket than normal.
- Risk ratio: how many times more likely an outcome is in one group versus another; above 1 means higher risk.
- GRADE: a standard scale (high to very low) for how certain the evidence behind a finding is.