Managing ocular surface disease in patients with glaucoma
Strategies for treating glaucoma should be minimally invasive to reduce stress, damage to eye
Ocular surface disease (OSD) is an extremely common entity, so it should be no surprise that it can frequently be found in patients with glaucoma.
Ocular surface disease index (OSDI) scores are normal in about 41% of patients with glaucoma, demonstrate mild to moderate dry eye disease (DED) in about 33%, and severe dry eye in 26%.1
A study by Rossi and colleagues reviewing tear break up time (TBUT), corneal staining, and OSDI scores in patients with glaucoma grouped patients into four categories.2 Five percent of those on zero medications had DED; 11% on one medication had DED; 39% on two medications had DED; and 40% of those on three medications had DED.
The conclusion is obvious: The more medications that patients take, the more likely it is for patients to complain or exhibit signs of dry eye.
OSD can negatively impact quality of life and cause significant visual symptoms, with the potential to impact both the quantity and quality of patients’ vision. There are many similarities in the characteristics of patients affected by either OSD or glaucoma—for example, older age, postmenopausal status among women, and presence of comorbidities for which systemic medications are needed. Of course, both OSD and glaucoma are progressive and chronic conditions, and so for each, earlier treatment usually portends better outcomes.
Importantly, OSD can be both an instigator for and reason why patients are less than optimally compliant with medical therapy—leaving aside that untreated OSD can also potentially slow down healing after incisional surgeries, leaving patients at risk for discomfort and compromised vision.
Compliance with medical therapy is a multifactorial and difficult problem in glaucoma, although one of the most common reasons patients fail to apply topical therapies is due to associated ocular discomfort.
The tearing, burning, fluctuating vision, pain, redness, and other symptoms associated with OSD are more readily apparent than glaucoma symptoms, and, thus patients may become concerned with the immediate cause of their visual symptoms and incorrectly attribute them to a side effect of the medication.