Ocular surface strategies are a must for treating patients with glaucoma

Article

As a chronic disease, glaucoma requires long-term, lifetime treatment, often with multiple ophthalmic medications.

The prevalence of ocular surface disease (OSD) is high in glaucoma patients.1 A number of factors-including increased age and medications typically taken by seniors, such as antihypertensives, antidepressants, and antihistamines-can cause dry eye symptoms and OSD. Additionally, repeated exposure to certain preservatives used in glaucoma medications can exacerbate this condition.

In a study of 630 glaucoma or ocular hypertension patients on topical IOP-lowering medications, nearly half had OSD index scores reflecting at least mild OSD symptoms; more than a quarter were classified as having moderate or severe OSD.2

BAK toxicity

Although benzalkonium chloride (BAK) does a remarkable job of keeping multi-dose eye drops sterile, animal experiments and clinical studies have shown that BAK can have dose-dependent toxic effects, compromising tear film stability and causing irritation to the cornea and conjunctiva. These ocular side effects may cause symptoms such as stinging, burning, and dryness.1,4

Considerable evidence also shows that preservatives can compromise the integrity of the tear film through their detergent effect on the lipid layer. This reduces tear film stability, causing excessive evaporation and resulting in increased ocular dryness.5,6,7 An impaired tear film can predispose the eye to inflammation and conjunctival metaplasia.

In addition, preservatives can affect the goblet cells by reducing their number and production of the protective mucin layer.8 Other effects of excessive preservative use include conjunctival epithelium inflammation and subconjunctival fibrosis.1

The side effects associated with long-term use of preserved anti-glaucoma medications can also adversely impact patient compliance with therapy and the likelihood of successful treatment.9

Recent Videos
Billy R. Hammond details the study, which explored how HEV-light filtering, specifically in the 380-440 nanometer range, impacts visual comfort for patients with presbyopia.
Dr Andrew Pucker at the American Academy of Optometry meeting in 2024
Steve Ferrucci, OD, FAAO, discussed the detection and treatment of geographic atrophy during his AAOpt 2024 lecture, "Imaging Techniques and Emerging Therapies for Geographic Atrophy."
Dr. Jessilin Quint gives an overview on next steps after treating dry eye
Ahmad Fahmy at AAOpt on neurotrophic pain in OSD
Raman Bhakhri, OD, FAAO, details AAOpt 2024 talks
Erin Tomiyama, OD, PhD, FAAO, discusses fitting lenses, young adults with binocular vision issues, and emerging presbyopia in patients.
Jamie Kuzniar, OD, FAAO, FSLS, overviews the basics on what to look out for complications-wise in corneal transplant patients that may require a referral.
Dr. Lisa Hornick goes over cosmetic habits and digital eye strain factors in OSD
Dr Carolyn Majcher chats about GA and posterior uveitis at AAOpt 2024
© 2024 MJH Life Sciences

All rights reserved.