Prevalence of dry eye more than 70% in patients treated with glaucoma eye drops
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Key takeaways:
- Dry eye prevalence based on Ocular Surface Disease Index score was 69.8% in glaucoma patients.
- More than half (56.1%) of glaucoma patients had subjective signs of dry eye.
Dry eye disease is common in glaucoma patients treated with hypotonizing eye drops, with 56.1% of patients reporting subjective signs of dry eye, according to a study in the Open Journal of Ophthalmology.
“Few studies have been carried out in Cameroon on DES in glaucoma patients,” Josiane Mare Njoya, MD, and colleagues at the University of Garoua in Cameroon, wrote. “The aim of our study is therefore to determine the prevalence of dry eye syndrome in glaucoma patients taking hypotonizing eye drops and to deduce the associated factors in our environment.”
In a cross-sectional, analytical study, Njoya and colleagues examined 73 patients with glaucoma (146 eyes) aged 15 years and older (average age, 47.2 years; 45% women) at the Garoua Regional Hospital. Participants, who had been using eye drops for at least 3 months, completed an Ocular Surface Disease Index questionnaire and underwent a complete ophthalmological examination, including tear breakup time test.
The researchers found that 56.1% of patients had subjective signs of dry eye, and 47.9% had meibomian gland dysfunction.
The average duration of eye-drop treatment was 2.9 years (range, 1-13 years). Most patients (83.5%) had been treated for more than 1 year, and more than half (55.7%) were treatment compliant. Length of treatment was a significant factor associated with dry eye (P < .05).
According to OSDI score, the prevalence of dry eye was 69.8%, with TBUT results demonstrating dry eye in 83.7% of right eyes and 79.4% of left eyes.
“We therefore recommend that glaucoma patients undergo an ocular surface examination before starting antiglaucoma eye drops and that non-preserved eye drops be used as much as possible for long-term follow-up,” the researchers wrote.
Perspective
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The dry eye and glaucoma nexus is one of the most important challenges in eye care today. While dry eye itself has severe quality of life implications, the fact that the condition can lead to discontinuation of glaucoma therapy may be a significant factor in vision loss. Therefore, addressing blepharitis and meibomian gland dysfunction (MGD) can prevent glaucoma-related blindness.
Benzalkonium chloride (BAK), the most-used preservative, is linked to the initiation or aggravation of ocular surface disease, with both time- and dose-dependent toxicity on the conjunctiva and cornea. In this study, glaucoma treatment duration of more than a year was associated with dry eye. The pathological process of BAK toxicity was initiated through the induction of squamous metaplasia of the conjunctival epithelium.
This study suggests that glaucoma patients undergo a dry eye, or ocular surface, examination before starting antiglaucoma eye drops and that non-preserved eye drops be used as much as possible. Interestingly, the authors found the corneal sensitivity of glaucoma patients treated with eye drops appears to be diminished. This may explain why subjective dry eye symptoms were less common than ocular signs and ocular surface disease.
MGD was also found in about half of patients (47.9%), highlighting the critical importance of addressing the root cause of dry eye through in-office and at-home therapies beyond lubrication. Carefully screening glaucoma suspects for dry eye and preemptively treating MGD and blepharitis can ultimately help prevent glaucoma-related vision loss.
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