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Ocular surface disease common in patients using antiglaucoma eye drops
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The number of eye drops and eye drops containing benzalkonium chloride may contribute to the prevalence of ocular surface disease in glaucoma patients, according to a study recently published in Optometry and Vision Science.
Ramli and colleagues conducted a cross-sectional, case-comparison study to assess the prevalence of ocular surface disease (OSD) and the effect of various medications on OSD.
Researchers compared OSD presence among 105 glaucoma participants using topical antiglaucoma medications and 102 control participants not using topical medications. They evaluated OSD presence by utilizing Ocular Surface Disease Index (OSDI) questionnaire grading, corneal staining, Schirmer’s test and the tear film break-up time (TBUT) test.
Researchers reported that more glaucoma participants had corneal staining, moderate OSDI symptoms and abnormal Schirmer’s tests than control participants. Additionally, they determined an association between abnormal TBUT and higher numbers of topical medications and drops that contained benzalkonium chloride (BAK). Participants on a drop with BAK were three times more likely to show abnormal OSDI.
"Glaucoma subjects on topical antiglaucoma drops have a significantly higher prevalence of OSD than those who are not on any medications," the authors concluded. "The prevalence may increase with increasing numbers of eye drops and using BAK-containing eye drops, which is likely to be due to toxic effects of the preservative." – by Chelsea Frajerman
Disclosure: The authors report no relevant financial disclosures.Perspective
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Blair Lonsberry, OD, FAAO
One of the more difficult aspects of treating patients with glaucoma is ensuring adherence to the prescribed IOP-lowering drop regimen. One potential cause of nonadherence is topical ocular irritation associated with IOP-lowering drops. Of particular concern are those medications that contain preservatives, particularly BAK.
The authors of this study found that patients taking glaucoma medications had a higher prevalence of ocular surface disease (OSD) than patients not taking topical medications, though this result varied depending on which OSD test was used. This highlights the variability of the different tests we have to diagnose OSD and reminds us that there is not a single universal test to assess all patients.
Interestingly, the authors found a high incidence of OSD in patients taking nonpreserved timolol, so, clearly, preservatives alone cannot account for the high OSD presence in patients taking glaucoma medications.
In any event, this study highlights the importance of paying particular attention to patients who take IOP lowering drops, particularly those that are BAK-preserved, and assessing/managing the increased prevalence of OSD. Careful OSD management improves patient comfort and likely assists in glaucoma treatment by leading to better treatment adherence.
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