Periorbital Fat Atrophy With Topical Bimatoprost in Glaucoma, Ocular Hypertension, and Cosmetic Use: Systematic Review and Meta-Analysis
Laila Sheather, Zeena Kailani, Aljeena Rahat Qureshi, Zaynab Somani, Sangsu Han, Sohel SomaniPurpose:
To synthesize evidence on bimatoprost-associated periorbital fat atrophy, compare outcomes across prostaglandin analogues, and evaluate reversibility after discontinuation.
Methods:
PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to August 2025 according to an a priori protocol (International Prospective Register of Systematic Reviews CRD420251107027). Studies evaluating periorbital structural changes in human subjects using topical bimatoprost for glaucoma, ocular hypertension, or cosmetic indications were included. Risk of bias was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses estimated risk ratios comparing bimatoprost with latanoprost and travoprost for deepening of the upper eyelid sulcus, periorbital fat loss, enophthalmos, and dermatochalasis involution.
Results:
Forty-five studies comprising 7,106 participants (3,176 bimatoprost-exposed) were included. Meta-analysis of five comparative studies (742 eyes) demonstrated a significantly higher risk of deepening of the upper eyelid sulcus (risk ratio, 2.92 [95% CI, 1.98–4.30]; Grading of Recommendations Assessment, Development, and Evaluation = low) and periorbital fat loss (risk ratio, 3.10 [95% CI, 1.07–8.99]; Grading of Recommendations Assessment, Development, and Evaluation = very low) with bimatoprost versus latanoprost. No significant differences were observed between bimatoprost and travoprost for any outcome (Grading of Recommendations Assessment, Development, and Evaluation = very low). Reversibility was variable; deepening of the upper eyelid sulcus showed the greatest resistance to recovery.
Conclusions:
Bimatoprost carries a significantly elevated risk of periorbital fat atrophy compared with latanoprost, with nearly three-fold increased risk; however, the certainty of evidence is low to very low. Bimatoprost and travoprost demonstrate equivalent periorbital adverse effect profiles, suggesting that switching between them is unlikely to reduce periorbital effects. These findings support the preferential use of latanoprost when periorbital appearance is a priority. Limitations include heterogeneity in outcome assessment and predominance of observational designs.