ABSTRACT
PURPOSE: To study the clinical and the functional findings in glaucomatous patients under preserved eye drops having ocular surface alterations and to analyze their risk factors. METHODS: A cross-sectional study of 155 glaucomatous patients was conducted. All of them answered the "Ocular Surface Disease Index" (OSDI) questionnaire and had a complete and precise evaluation of the ocular surface state including a Schirmer I test, a tear break-up time evaluation, eyelid, conjunctival, and corneal examination with a Fluorescein and a Lissamin green test. We studied factors that could influence the OSDI score and each type of ocular surface alteration (age, sex, glaucoma treatment duration, number and type of the active principle, and Benzalkonium Chloride [BAK] use). RESULTS: BAK was used in 80% of cases. The OSDI score was ≥13, in 61.3% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The main predictors of OSDI score increase were the glaucoma treatment duration (P = 0.01, t = 2.618), the number of molecules used (P = 0.018, t = 2.391), and the use of BAK (P = 0.011, t = 2.58). The severity of the biomicroscopic signs correlated with these same risk factors. Fixed combination was statistically associated with a lower incidence of superficial punctate keratitis (SPK) and corneal and conjunctival staining in the Lissamine green test (P < 0.001). Beta-blockers were associated with a significantly higher risk of SPK and corneal or conjunctival staining in the Lissamine green test (P < 0.001). CONCLUSIONS: Preserved antiglaucomatous eye drops alter the patients' ocular surface. The main risk factors were advanced age, duration of glaucoma treatment, multiple therapies, and the use of BAK.
ABSTRACT
BACKGROUND: the antiglaucomatous treatments interact with the ocular surface and can induce its alteration which may affect the therapeutic results Aim : to describe the interactions between the ocular surface and anti-glaucoma medications and to propose practical attitudes to prevent and manage this issue. METHODS: a retrospective study about 100 patients with a primary opened angle glaucoma treated with anti-glaucomatous drops containing preservatives. We performed an exhaustive examination of the ocular surface with fluorescein instillation to search superficial punctuate keratitis and to evaluate the break up time. All patients had a Schirmer test I. RESULTS: our patients were under monotherapy in 46% ,two medications in 36%, three medications in 11% and four medications in 7% .Beta-blockers were statistically related to the conjunctival hyperaemia (p = 0.014), BUT alteration (p = 0.001) and Schirmer test ≤ 5 mm (p = 0.0001). Prostaglandin analogues were statistically related to a Schirmer test ≤ 5 mm (p = 0.02). The use of more than two anti-glaucomatous medications was linked to the severity of the clinical signs. CONCLUSIONS: anti glaucoma drops affect the ocular surface through several mechanisms: allergic reaction, direct and indirect toxicity of the active agents as well as their preservatives. The risk is increased by the prior ocular surface abnormalities in these patients. This disease influences the quality of life and leads to poor adherence to treatment.
