Topical prostaglandin analogs, which have become first-line therapy in the medical
management of glaucoma, have an excellent safety profile with regard to systemic side
effects, but are associated with several ocular side effects. Some of these are common,
with no apparent serious consequences other than cosmetic, whereas others are much
less common but represent potentially sight-threatening side effects. The former group
includes conjunctival hyperemia, elongation and darkening of eyelashes, induced iris
darkening, and periocular skin pigmentation. The latter group of side effects, which
are relatively rare and lack definitive causal relationship to prostaglandin analog
therapy, includes iris cysts, cystoid macular edema, anterior uveitis, and reactivation
of herpes simplex keratitis. Most of the literature regarding side effects associated
with prostaglandin analogs involves the use of latanoprost, probably because it was
the first to be studied. There is no evidence, however, aside from less conjunctival
hyperemia with latanoprost, that the commercially available prostaglandin analogs
differ significantly with regard to side effects.