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Impact of eyelid closure on the intraocular pressure lowering effect of prostaglandins: a randomised controlled trial
  1. Eugenio A Maul,
  2. David S Friedman,
  3. Harry A Quigley,
  4. Henry D Jampel
  1. The Wilmer Eye Institute at Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Professor Henry D Jampel, Maumenee B-110, 600 N. Wolfe St, Baltimore, MD 21287, USA; hjampel{at}


Background/aims To determine if eyelid closure (ELC) after topical prostaglandin instillation provides greater intraocular pressure (IOP) reduction than prostaglandin instillation without ELC.

Methods Patients receiving chronic bilateral prostaglandin monotherapy were enrolled in this study. The study intervention, ELC, was randomly assigned to one eye, while the fellow eye served as control. ELC was performed for either 1 min or 3 min. After a 1-day washout, the IOP was measured in a masked fashion at baseline, 1 h and 24 h, and at a final visit that took place 7–14 days after enrolment. All visits were scheduled during the morning, and every individual patient's visits occurred at similar times during the day. The main outcome was difference between intervention eye and control eye in IOP-lowering from baseline.

Results 51 patients meeting eligibility criteria were enrolled: 25 were randomised to ELC for 1 min and 26 to ELC for 3 min in the intervention eye. The pooled IOP-lowering difference (95% CI, p value) in intervention versus control eyes was 0.24 mm Hg (−0.5 to 0.9, p=0.50), 0.24 mm Hg (−0.7 to 1.2, p=0.61) and 0.24 mm Hg (−0.7 to 1.2, p=0.61) in the overall group, 1 min ELC subgroup and 3 min ELC subgroup, respectively. The effect of ELC did not change significantly across visits.

Conclusions ELC did not provide significant additional IOP reduction compared with no ELC in patients using chronic prostaglandin monotherapy.

  • Randomised controlled trials
  • glaucoma
  • open-angle/drug therapy
  • intraocular Pressure/drug effects
  • Ophthalmic Solutions
  • Treatment Medical
  • Glaucoma

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  • Funding Study partially supported by NIH grant EY01765 to conduct statistical analyses.

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval The study followed the tenets of the Declaration of Helsinki, and was approved by the Johns Hopkins Joint Committee for Clinical Investigation (protocol number NA_00021272). The study adhered to Health Insurance Portability and Accountability Act guidelines.

  • Provenance and peer review Not commissioned; externally peer reviewed.