Foreshortening of the Inferior Conjunctival Fornix Associated with Chronic Glaucoma Medications

Schwab, Ivan R.; Linberg, John V.; Gioia, Vincent M.; Benson, William H.; Chao, Gung mei

doi:10.1016/s0161-6420(92)32001-9

Cited by 115 publications

(71 citation statements)

References 17 publications

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“…Long-time usage of antiglaucomatous agents was shown to cause irreversible chronic conjunctival inflammation and fibrosis which yields a low success rate in filtration surgery [4,5,6,7,11,12,13,14,38,39,40]. It was shown that the changes were more prominent in patients treated with more than one drug and with increased duration of time [7, 11].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Alagöz

Bayer²,

Boran³

et al. 2008

Ophthalmologica

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Purpose: To compare the subjective symptoms, conjunctival hyperemia, tearing response and conjunctival cytological changes secondary to topical administration of bimatoprost and travoprost for 6 months. Methods: Newly diagnosed primary open-angle glaucoma patients were randomly prescribed bimatoprost (35 cases) or travoprost (42 cases). Two patients in each group were excluded because they did not appear at their appointments regularly. Thus, 33 and 40 patients completed the study in the bimatoprost and travoprost groups, respectively. Redness, itching, foreign-body sensation, pain and discomfort were assessed by a questionnaire, and patients were examined for conjunctival hyperemia. Schirmer’s I and break-up time tests were performed, and impression cytology of conjunctiva was evaluated. Results: Subjective symptoms were similar in both groups. The only subjective symptom that changed significantly was redness. The change in conjunctival hyperemia along the study period correlated with the patient-reported redness in both groups, being highest on day 30. Schirmer’s test I and break-up time did not change with time and were similar in both groups. The impression cytology grade increased with time in both groups with the only significant difference between groups on day 90 (higher in the bimatoprost group). Conclusion: We observed conjunctival hyperemia as the most common side effect of bimatoprost and travoprost. Tear film functions were not affected by these drugs while cytological alterations were.

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Section: Discussionmentioning

confidence: 99%

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Alagöz

Bayer²,

Boran³

et al. 2008

Ophthalmologica

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“…12 While some shortening of the conjunctival fornix occurs with age, this is increased by topical therapy. 10 In these patients, fibroblasts, macrophages, lymphocytes, and mast cells are present in the superior conjunctival substantia propria 11 and there is a loss of goblet cells in the epithelium.…”

Section: Pathogenesismentioning

confidence: 99%

Corneal toxicity: the epithelium and stroma in iatrogenic and factitious disease

Dart

2003

Eye

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Corneal toxicity is caused by chemical trauma and by iatrogenic and factitious disease, which are often overlooked, and which are reviewed here. The clinical signs of iatrogenic disease are usually nonspecific and identical to those resulting from other causes of surface disease. Factitious disease is either the result of mechanical trauma or the abuse of toxic eye drops. One epidemiological study, in a tertiary setting, identified 13% of keratoconjunctivitis cases as iatrogenic. Healing was prolonged taking 7-93 (median 28.5) days. Pathogenic mechanisms vary widely with different drugs and include subclinical scarring, pseudopemphigoid, drug-induced ocular cicatricial pemphigoid, and toxic follicular reactions. There is little readily available data either on the probability of the development of adverse reactions or for the comparison of different drugs. The assessment of the toxicity of topical drugs is currently by the Draize test in rabbits. New in vitro tests on human corneal epithelial cell cultures include ATP assays for cell viability, scanning EM of epithelial microvilli, and vital staining to assess cell membrane permeability and intracellular esterase. Despite their simplicity, these test systems can correlate well with clinical toxicity and provide a toxicity index for drug comparisons. Treatment requires drug withdrawal or substitution by nonpreserved and less toxic preparations. Factitious injury is rare, difficult to diagnose, and should only be considered when all other diagnoses have been excluded. Prevention requires a high level of awareness of the potential for iatrogenic disease, particularly in the high-risk setting of chronic ocular surface disease.

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“…The use of longterm antiglaucoma medications is related to conjunctival foreshortening and shrinkage, which may be associated with an ocular pemphigoid-like condition or evolve into severe scarring conjunctivitis with definitive corneal opacities (Schwab et al 1992). …”

Section: Effects On Surgery Outcomesmentioning

confidence: 99%

Detrimental effect of preservatives in eyedrops: implications for the treatment of glaucoma

Baudouin

2008

Acta Ophthalmologica

231

149

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ABSTRACT.Antiglaucoma medications are often associated with ocular adverse reactions such as dry eye, and burning or stinging sensations. These undesirable effects may lead to treatment discontinuation and reduced quality of life in patients with glaucoma. Antiglaucoma medications usually contain benzalkonium chloride (BAK) as a preservative. Animal studies, in vitro studies and in vivo experiments have demonstrated various adverse effects of BAK. Clinical studies have also shown an increased incidence of adverse events with BAK and have demonstrated that the withdrawal of preservatives reduces these effects. Collectively, these data suggest that preservative-free antiglaucoma treatments have clinically relevant benefits for patients.

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Foreshortening of the Inferior Conjunctival Fornix Associated with Chronic Glaucoma Medications

Cited by 115 publications

References 17 publications

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Corneal toxicity: the epithelium and stroma in iatrogenic and factitious disease

Detrimental effect of preservatives in eyedrops: implications for the treatment of glaucoma

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