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    Fighting against glaucoma-therapy related ocular surface disease

    Preservative-free artificial tear substitution should be used when OSD is detected


    Detecting ocular surface disease

    In a busy glaucoma clinic, it is not necessary to measure tear film break-up time, tear secretion and tear osmolarity. In contrast, asking the patients about sudden tearing, red eyes and feelings of eye discomfort takes only a few seconds; and paying attention to the conjunctiva (folds, grainy tear film, redness, filaments), lid margin (Meibomian gland status) and ocular surface staining after fluorescein instillation but before measuring intraocular pressure, is similarly fast.

    When OSD is detected, it is recommended to introduce PF artificial tear substitution, and to start topical cyclosporine medication, which has been increasingly available in the past years. Topical cyclosporine therapy targets inflammation, an important and obligatory part of OSD.

    However, these efforts, which may be enough for patients who only have OSD, are not sufficient for patients with OSD and topically treated glaucoma. In the latter, common situation, the topical glaucoma medication also needs to be changed for PF medication, in order to eliminate the detrimental effects of BAK on the ocular surface.

    Since PF glaucoma medication choices are widely available for almost all drug classes, no technical obstacles against this treatment change exist in most countries. However, ophthalmologists need to understand that OSD does cause suffering to the patients, and need to pay attention to the patients’ complaints and OSD signs.

    This is not difficult and nor is it time consuming. It only requires the ophthalmologist to have the intention to pay attention to detecting OSD.

    E-mail: [email protected]

    Professor Holló works at the Head, Glaucoma and Perimetry Unit of the Department of Ophthalmology, Semmelweis University, Budapest, Hungary.






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    2. Baudouin C, Renard J-P, Nordmann J-P, Denis P, Lachkar Y, Sellem E, 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;23:47–54.


    3. Labbe´ A, Pauly A, Liang H, Brignole-Baudouin F, Martin C, Warnet J-M, et al. Comparison of toxicological profiles of benzalkonium chloride and polyquaternium-1: an experimental study. J Ocul Pharmacol Ther. 2006;22:267–78.

    Professor Gábor Holló

    Professor Gábor Holló is the Director of Glaucoma and Perimetry Unit of the Department of Ophthalmology at Semmelweis ...

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