Topical glaucoma treatments may result in meibomian gland dysfunction
Topical glaucoma medication may alter the structure and function of patients’ meibomian glands, particularly if preservative is present in the drop, according to data published in Optometry and Vision Science.
“Glaucoma medication is associated with changes in meibomian glands morphology, including decreased acinar area, acinar density and homogenous acinar wall morphology. Several studies have demonstrated the negative effects of glaucoma medication in the meibomian glands,” Diana Soriano, OD, MSc, of the department of ophthalmology at Miguel Servet University Hospital in Spain, and colleagues wrote. “Therefore, the aim of this study was to evaluate clinically the meibomian glands and lid margin in patients with glaucoma treatment and the influence of IOP-lowering medication regimens on these structures.”
The prospective study included 223 patients, 92 with untreated ocular hypertension and 131 with open-angle glaucoma treated with topical medication.
Noncontact meibography was performed to assess the structure of the meibomian glands, and gland function was assessed by measurement of expressibility, duct appearance and Marx line location. Researchers also assessed tear osmolarity, corneal staining and ocular symptoms. Within the glaucoma group, variables were compared according to the presence of preservative in topical medication.
Higher meibography was increased in the glaucoma group as compared with the control group (1.76 vs. 1.35; P < .002). The expressibility of meibum was also higher in the glaucoma group as compared with the control group in both meibum quantity (1.11 vs. 0.59; P < .001) and meibum quality (0.85 vs. 0.47; P < .001). The glaucoma group also showed a higher degree of corneal staining (P < .001).
Patients using only one eye drop as treatment presented with a lower Marx line temporal value than patients using two eye drops (1.32 vs. 1.90; P < .001). However, the Marx line location score was higher in both central Marx line (P < .001) and temporal Marx line (P < .003) in patients using medication containing preservative compared with patients using preservative-free treatment.
Marx line central (P = .004), Marx line temporal (P = .049), quantity of meibum expression (P = .046) and quality of meibum expression (P = .03) were found to have predictive ability to detect meibomian gland dysfunction-related dry eye disease.
“It is important to identify meibomian gland dysfunction in patients treated with glaucoma drugs to improve adherence and quality of life and to reduce complications associated with medical treatment,” the researchers wrote. “Pharmaceutical industries should consider studies like this to investigate new drug formulations that may be safer for the ocular surface.”
Perspective
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Scientific studies have established a strong association between glaucoma medication use and dry eye/meibomian gland dysfunction (MGD). While glaucoma is asymptomatic yet potentially blinding, MGD can be extremely bothersome but does not commonly cause vision loss. However, the negative impact of MGD has on all patients (and glaucoma sufferers in particular) is likely greatly underestimated.
Preventing damage to the meibomian glands is essential, and early intervention in glaucoma suspects could decrease their complications with medication. This will likely lead to less ocular surface disease and better adherence with pressure-reducing drops. Simply put, treating dry eye may help prevent blindness from glaucoma. The other piece of the puzzle is that nonpreserved medications and formulations that cause less damage to the meibomian glands.
For best results, at-home and in-office dry eye treatments should be employed in concert (just like teeth need daily brushing as well as periodic in-office cleaning). Merely offering patients artificial tears while not addressing the root cause of their symptoms is no longer acceptable. It’s time to stop thinking about dry eye as a minor issue and realize it not only harms quality of life but can be a major reason for vision loss in glaucoma patients.
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