Sunken Eyes from Glaucoma Drops

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sunken eyes from glaucoma drops
anatomy of the eye (click on image to enlarge)

How is glaucoma related to sunken eyes?

Sunken eyes from glaucoma drops is not an uncommon problem. Glaucoma is an eye condition that usually requires treatment with drops to lower the pressure in the eye.  Some of the drops are known to cause the eyes to appear sunken in the socket.  An early symptom is superior sulcus recession, which is a loss of fullness of the upper lid.  Later, the eye may appear deeper or lower in the socket.  

sunken eye
Sunken left eye due to artificial eye implant. Note the upper lid appears less full. Also the artificial eye is sunken deeper in the socket and is positioned slightly lower compared with the right eye. This appearance is similar to what may occur with the use of prostaglandin eye drops for glaucoma. Image courtesy of the American Academy of Ophthalmology.

Do all glaucoma drops cause sunken eyes?

No. There are many classes of drugs used as eye drops to lower intraocular pressure.  Among the many classes of drops available to treat glaucoma, only prostaglandin analogues are known to cause sunken eyes.  Examples of glaucoma drops in this class include Xalatan (Xelpros, latanoprost), Travatan (travoprost), Lumigan (Durysta, bitamoprost), Zioptan (Tafluprost), and Vyzulta.  This class of eye drops also may cause the color of the iris to turn brown, and the lashes may grow darker and longer.  Rarely, macular edema may cause blurred vision. 

What can be done to treat or prevent sunken eyes?

There is no treatment for sunken eyes once they occur from prostaglandin analogues.  Therefore, if sunken eyes are to be avoided, prevention is the key.  Although prostaglandin analogues are among the most effective drops to lower the intraocular pressure, there are other classes of drops to choose from.  They include the following:

  • Beta blockers effectively lower the pressure by 25-30%, but they may aggravate asthma.  
  • Alpha agonists also lower the pressure, but may cause low-grade inflammation in the eye.  
  • Cholinergics may be effective, but make the pupils small, which may affect night vision.  
  • Carbonic anhydrase inhibitors are effective, but may worsen pre-existing corneal edema.  
  • Rho-kinase inhibitors lower pressure, but often cause redness of the eyes.  It may also cause tearing due to reversible blockage of the tear duct in the eye lids.

Finally, if the prostaglandin class of eye drops is felt to be the best choice, Omlonti is a new drug (approved by the FDA in 2021) in this class that is less likely to cause sunken eyes.  However, among eyes with lens implants there may be a 5-15% chance of blurred vision from macular edema when using Omlonti.  Your glaucoma specialist will work to help choose the best medicine for you and will help to determine if laser or incisional eye surgery would be a preferred option to lower the eye pressure.

By Scott E. Pautler, MD

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