Periorbital Changes Following Glucagon-Like Peptide-1 Receptor Agonist Use: A Retrospective Cohort Study of Oculofacial Complications and Interventions

Purpose: The purpose of this study is to evaluate whether the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with periorbital changes in patients with type 2 diabetes mellitus (T2DM) or obesity. Methods: A retrospective cohort study was conducted using the TriNetX Research Network database. Patients with T2DM treated with insulin or other antidiabetic agents and who were GLP-1RA naive served as the T2DM control group. The obesity control group included patients with obesity (body mass index ≥30 kg/m 2 ) who neither had bariatric surgery nor T2DM and were GLP-1RA naive. Study groups included patients with T2DM or obesity treated with GLP-1RAs. Rates of blepharoptosis, brow ptosis, dermatochalasis, ectropion, and entropion were recorded alongside their respective rates of surgical repair as well as the frequency of rhytidectomy and botulinum A toxin use. Outcomes were assessed at 3 and 20 years postdrug approval for the obesity and T2DM study groups, respectively. Results: Patients with T2DM using any GLP-1RA were significantly more likely to develop brow ptosis ( p < 0.001) and receive botulinum toxin A ( p = 0.001) compared to controls. Patients with obesity using a GLP-1RA were significantly more likely to develop brow ptosis ( p = 0.004), dermatochalasis ( p < 0.001), and receive botulinum toxin A ( p < 0.001). Patients with obesity on a GLP-1RA were significantly more likely to undergo brow ptosis repair ( p = 0.001), blepharoptosis repair ( p < 0.001), blepharoplasty ( p < 0.001), and rhytidectomy ( p = 0.011) compared to controls. Conclusions: GLP-1RA use by patients with obesity or T2DM resulted in significant periorbital changes and subsequent repair. When compared to their respective controls, patients using GLP-1RAs for obesity observed more periorbital changes than those with TD2M, likely secondary to excess adipose tissue accumulation and loss.