GLP-1 Drugs Linked to Increased Risk of Periorbital Changes, Study Finds

The rapid weight reduction triggered by GLP-1 therapy has numerous health benefits, of course. However, an oculoplastics team from Bascom Palmer found that the ensuing loss of subcutaneous fat can lead to visually unwanted periorbital changes. Photo: Mary E. Boname, OD. Click image to enlarge. A study published in Ophthalmic Plastic and Reconstructive Surgery found GLP-1 receptor agonist use was associated with a higher risk of several periorbital changes;  in addition, patients using GLP-1 drugs for obesity were overall more likely to undergo corrective cosmetic or oculoplastic procedures than matched controls. Researchers from Bascom Palmer in Miami analyzed electronic health records from the TriNetX database to determine whether glucagon-like peptide-1 (GLP-1) receptor agonists were linked to oculofacial changes in patients with type 2 diabetes or obesity. They created separate cohorts for patients treated for diabetes beginning in 2005 and obesity beginning in 2021, comparing GLP-1 users with propensity score-matched patients who had not used such medications. Patients with preexisting “diseases of the eye, adnexa and periorbital and brow regions,” as well as patients with bariatric surgery prior to medication use, were excluded, the researchers explained in their paper. Outcomes tracked in the study included brow ptosis, blepharoptosis, dermatochalasis, ectropion, entropion and subsequent surgical or cosmetic interventions.After matching, the diabetes cohort included 334,288 patients in each group with a mean age of 60.7. Of these, 60.8% of subjects were white, 16.8% were Black and 6.5% were Asian. The obesity cohort included 270,923 patients per group with a mean age of 48.2; of these, 65.8% were white, 16.2% were black, 1.5% were Asian and 30% were Hispanic or Latino.Among diabetes patients, GLP-1 medication use was associated with more than three times higher risk of brow ptosis and greater use of botulinum toxin injections compared with controls. In the obesity cohort, GLP-1 users were nearly three times more likely to develop brow ptosis and dermatochalasis. They were also significantly more likely to undergo brow ptosis repair, blepharoptosis repair, blepharoplasty and rhytidectomy. The authors suggested that these findings were signs of “the rapid loss of subcutaneous fat leading to decreased support for periorbital muscles” and that in patients treated for obesity appeared to experience more pronounced changes because greater weight loss and preexisting excess adipose tissue may cause more “noticeable changes in facial contours.”They also acknowledged that the retrospective design, reliance on diagnostic coding and inability to assess duration of GLP-1 therapy limited the analysis. However, they noted that “a benefit of collecting data from a large database is that outliers or inappropriate coding from any one provider may be minimized when compared to thousands of other data points from other providers” and that they used “stringent criteria” to ensure maximum accuracy. They concluded that the findings support closer monitoring of periorbital changes as use of these medications continues to expand.Click here for the journal source. Saffar PS, Davila N, Pradeep T, et al. Periorbital changes following glucagon-like peptide-1 receptor agonist use: a retrospective cohort study of oculofacial complications and interventions. Ophthalmic Plastic and Reconstr Surg. July/August 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.