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Tip of the Month
Tip of the month - Glaucoma patients on topical treatment should be routinely checked for signs of ocular surface disease even if they are asymptomatic
Glaucoma patients on topical treatment should be routinely checked for signs of ocular surface disease even if they are asymptomatic

Publishing date: May 2020

Tip Editors: Frances Meier-Gibbons, Humma Shahid, Karl Mercieca, Francisco Goni
Tip reviewer: Roger Hitchings

The Science behind the Tip

The prevalence of ocular surface disease is significantly higher in glaucoma patients (1). While generally accepted that preserved topical antiglaucoma medication can have significant side effects, preservative-free medication may also be associated with ocular surface disease.
Betablockers, prostaglandin analogues, carbonic anhydrase inhibitors and pilocarpine are all shown to potentially cause an exacerbation of ocular surface disease (2, 3, 4).

In dry eye, changes in the subbasal corneal nerve plexus can result in decreased corneal sensitivity, which can mask subjective symptoms of ocular surface disease, thus feigning good tolerance of the topical therapy (5).

Therefore, it is recommended to not only ask the patient for symptoms, but to specifically check for signs of ocular surface disease.

Contributor: Cornelia Hirn, Vienna, Austria




References

1. Baudouin C, Renard J-P, Nordmann J-P, et al. Prevalence and risk factors for ocular surface disease among patients treated over the long term for glaucoma or ocular hypertension. Eur J Ophthalmol 2013; 23(1): 47-54.
2. Kuppens EVMJ, de Jong CA, Stolwijk TR, et al. Effect of timolol with and without preservative on the basal tear turnover in glaucoma. Br J Ophthalmol 1995; 79: 339-342
3. Chen H.Y., Lin C.L., Tsai Y.Y., et al. Association between glaucoma medication usage and dry eye in Taiwan. Optom Vis Sci. 2015;92(9): e227–e232.
4. El Hajj Moussa W.G., Farhat R.G., Nehme J.C. Comparison of efficacy and ocular surface disease index score between bimatoprost, latanoprost, travoprost, and tafluprost in glaucoma patients. J Ophthalmol. 2018; 2018:1319628.
5. Labbé A, Liang Q, Wang Z, et al. Corneal Nerve Structure and Function in Patients with Non-Sjögren Dry Eye: Clinical Correlations. Invest Ophthalmol Vis Sci. 2013; 54: 5144–5150.



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