Can Latanoprost Cause Droopy Eyelids? Understanding Ptosis from Eye Drops

October 11, 2025 •

4 min read

According to a 2013 study in Review of Optometry, patients using prostaglandin analogues such as latanoprost were significantly more likely to develop upper-lid ptosis. This confirms that a direct link exists between the use of these eye drops and the development of droopy eyelids. The phenomenon is related to a condition called Prostaglandin-Associated Periorbitopathy (PAP), which can alter the delicate tissue surrounding the eye.

Quick Summary

Latanoprost, a medication for glaucoma, can cause droopy eyelids by inducing periorbital fat atrophy. This article details the broader condition, PAP, explains the mechanism behind the side effect, and discusses the potential for reversal upon discontinuation of the medication.

Key Points

Latanoprost can cause ptosis: The eye drop medication latanoprost is known to be a cause of droopy eyelids (ptosis).
Linked to Prostaglandin-Associated Periorbitopathy (PAP): Ptosis from latanoprost is a component of PAP, a syndrome involving multiple changes to the tissue surrounding the eye.
Mechanism involves fat atrophy: The drooping is primarily caused by periorbital fat atrophy, which is the loss of fat around the eye socket.
Discontinuation can reverse effects: Stopping the use of latanoprost often leads to a partial or complete reversal of the droopy eyelids.
Effects may not be fully reversible: In some instances, the ptosis may persist even after discontinuing the medication, potentially requiring surgical intervention.
Technique can minimize risk: Proper eye drop administration, including punctual occlusion, can minimize systemic absorption and reduce the risk of periorbital side effects.
Ptosis is a known risk of PGAs: The risk of ptosis and other periorbital changes is associated with the class of drugs known as prostaglandin analogues (PGAs).

The Link Between Latanoprost and Droopy Eyelids (Ptosis)

Ptosis, the medical term for a droopy upper eyelid, is a known but less common side effect associated with the long-term use of latanoprost and other prostaglandin analogue (PGA) eye drops. While latanoprost is highly effective at lowering intraocular pressure (IOP) to treat glaucoma, its pharmacological effects can extend beyond the intended therapeutic action. The result is a series of changes to the periorbital area, which can include the drooping of the eyelid itself or even the eyelashes, a condition known as lash ptosis.

The Mechanism Behind the Side Effect

The primary cause of latanoprost-induced ptosis is believed to be periorbital fat atrophy, which is a reduction in the volume of the fat tissue around the eye socket. This fat loss can cause the upper eyelid to retract or appear sunken, leading to a deepened upper eyelid sulcus (DUES) and contributing to the droopy appearance. Research indicates that PGAs may cause the loss of this vital orbital fat, leading to the characteristic changes observed in affected individuals. These effects are most apparent in patients using the medication in only one eye, where the difference between the treated and untreated eye becomes noticeable over time.

What is Prostaglandin-Associated Periorbitopathy (PAP)?

The constellation of periorbital changes caused by latanoprost and other PGAs is collectively termed Prostaglandin-Associated Periorbitopathy (PAP). This syndrome involves a range of cosmetic alterations that can progress over time. The key features of PAP include:

Upper Eyelid Ptosis: Drooping of the upper eyelid.
Deepening of the Upper Eyelid Sulcus (DUES): The upper eyelid appears hollowed or sunken.
Periorbital Fat Atrophy: Loss of fat tissue in the area around the eye.
Eyelid Skin Darkening: Increased pigmentation of the skin on the eyelids.
Thicker, Longer, and Darker Eyelashes: A condition called hypertrichosis.

Reversibility and Management of Latanoprost-Induced Ptosis

If you experience droopy eyelids while on latanoprost, it is crucial to consult your ophthalmologist. The most common management strategy involves discontinuing the medication, which often leads to a partial or complete reversal of the periorbital changes. Improvement can be observed within weeks of stopping the drops. However, some case reports suggest that in certain instances, the changes may not fully reverse. The degree of reversibility varies among individuals and may depend on the duration of use and individual response. For persistent cases of ptosis, surgical options may be available.

Comparison of Side Effects: Latanoprost vs. Other PGAs

Not all prostaglandin analogues are equal when it comes to the frequency and severity of periorbital side effects. The table below compares the known side effect profiles of three common PGAs used for glaucoma management.


Feature	Latanoprost (Xalatan)	Bimatoprost (Lumigan, Latisse)	Travoprost (Travatan)
Mechanism of Action	A prodrug ester that is converted to the active acid in the eye.	A prostamide that is a synthetic structural analog of prostaglandin.	A prodrug ester that is converted to the active acid in the eye.
Incidence of Ptosis	Documented incidence, generally considered relatively low but confirmed.	High incidence documented in studies; linked to levator muscle atrophy.	Higher incidence shown in studies, similar to bimatoprost.
Periorbital Fat Atrophy	Yes, a known component of PAP.	Yes, a significant and well-documented side effect.	Yes, a known component of PAP.
Eyelash Changes	Yes (longer, thicker, darker). Reversible in some cases.	Yes (longer, thicker, darker).	Yes (longer, thicker, darker).
Iris Darkening	Yes, can be permanent.	Yes, can be permanent.	Yes, can be permanent.
Reversibility	Periorbital effects often reversible upon discontinuation.	Periorbital effects may be partially reversible.	Periorbital effects often reversible upon discontinuation.

Minimizing the Risk of Periorbital Side Effects

To help prevent or minimize the development of side effects like ptosis and PAP, patients can employ proper eye drop instillation techniques. The Glaucoma Research Foundation suggests using punctual occlusion, which involves gently pressing on the inner corner of the eye near the tear duct for two to three minutes after applying the drop. This prevents the medication from draining into the systemic circulation and reduces its exposure to the periorbital tissues. Keeping the drop contained to the ocular surface can help reduce unintended side effects.

Conclusion

While latanoprost is a cornerstone of glaucoma treatment, it is important for both patients and clinicians to be aware of the potential for periorbital side effects, including droopy eyelids or ptosis. This effect is part of a larger syndrome called Prostaglandin-Associated Periorbitopathy (PAP), characterized by periorbital fat loss and deepening of the eyelid sulcus. In many cases, discontinuing the medication can reverse these changes. However, some effects, such as iris color changes, may be permanent, and in some rare cases, ptosis may require surgical correction. Always discuss any concerning side effects with your healthcare provider to find the best course of action for your eye health. For further information on managing PAP, you can refer to resources like the EyeWiki article on the topic.

Frequently Asked Questions

If you notice your eyelids drooping or appearing sunken while using latanoprost, especially if the changes are more prominent in the treated eye, it is possible the medication is the cause. The condition is gradual, so observing photos from before starting treatment can help identify changes. Consult an ophthalmologist for a proper diagnosis.

The reversibility of latanoprost's side effects varies. Periorbital changes like ptosis and fat atrophy often improve or resolve completely after discontinuing the medication. However, changes in iris color are typically permanent, and some case reports suggest that ptosis may also persist in some individuals.

Latanoprost-induced ptosis is a side effect caused by medication, often associated with other periorbital changes like fat atrophy. Age-related ptosis is a natural result of the levator muscle stretching or detaching over time. A medical professional can distinguish between the two based on your medical history and the specific characteristics of the drooping.

While it may not be entirely preventable, you can minimize the risk by using proper eye drop technique. Using punctual occlusion (pressing on the inner corner of your eye for 2-3 minutes after application) can reduce systemic absorption and the medication's effect on periorbital tissues.

For many patients, discontinuing latanoprost leads to a partial or complete reversal of periorbital changes, including ptosis, often within a few weeks to months. Your doctor can monitor your progress and advise on the best course of action.

Yes, other classes of glaucoma medications exist, such as beta-blockers (e.g., timolol) or carbonic anhydrase inhibitors, which do not typically cause periorbital fat atrophy or ptosis. If you are concerned about this side effect, discuss alternative treatment options with your doctor.

Latanoprost is a highly effective medication for controlling glaucoma and preventing vision loss. For many patients, the therapeutic benefits outweigh the cosmetic side effects, which are not experienced by everyone. Doctors will assess your individual needs and risks before prescribing the medication.