Meibomian Gland Performance in Glaucomatous Patients With Long-term Instillation of IOP-lowering Medications

Cho, Wan-Hua; Lai, Ing‐Chou; Fang, Po-Chiung; Chien, Chun-Chih; Tseng, Shin-Ling; Lai, Yu-Hsuan; Huang, Yu‐Ting; Kuo, Ming‐Tse

doi:10.1097/ijg.0000000000000841

Cited by 15 publications

(19 citation statements)

References 33 publications

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“…It is well known that different hypotensive drops present diverse local and systemic side effects, and some of them affect blood pressure [7], which in turn could influence the ocular surface temperature [20]. A decrease in the temperature of the ocular surface may lead to a decrease in the quality of the tear film since secretions from the glands such as the meibonium glands are negatively affected by lower temperatures [21]. The participants in this study used a wide variety of glaucoma medications.…”

Section: Resultsmentioning

confidence: 99%

Characterization of the ocular surface temperature dynamics in glaucoma subjects using long-wave infrared thermal imaging

García-Porta¹,

Gantes-Nuñez²,

Tabernero³

et al. 2019

J. Opt. Soc. Am. A

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We evaluated the dynamics of ocular surface temperature using thermal imaging in 21 glaucoma subjects and 19 healthy subjects. On opening of the eye, subjects with glaucoma showed significantly cooler temperatures in the central cornea compared to the control group. The upper eyelid was also significantly cooler just before the eye opened. Immediately after opening the eye, the dynamic of temperature change was different in the two groups. In subjects with glaucoma, the eyes cooled significantly faster, with an average decrease of 0.49°C during the first second compared to 0.24°C in the control group. Our results support the hypothesis that both the stability of the tear film and changes in the ocular blood supply in subjects with glaucoma play an important role in thermal dynamics of the ocular surface.

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Section: Resultsmentioning

confidence: 99%

Characterization of the ocular surface temperature dynamics in glaucoma subjects using long-wave infrared thermal imaging

García-Porta¹,

Gantes-Nuñez²,

Tabernero³

et al. 2019

J. Opt. Soc. Am. A

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“…Again, the study showed a significant difference in Marx line and breakup time according to the presence of meibomian gland dysfunction between the cases and controls 19 . Cho and colleagues reported that patients with glaucoma had significantly worse meibum quality, thinner lipid layer thickness, and lower meibomian gland secretion compared to healthy controls 20 …”

Section: Resultsmentioning

confidence: 90%

The impact of topical intraocular pressure lowering medications on the ocular surface of glaucoma patients: A review

Asiedu¹,

Abu

2019

Journal of Current Ophthalmology

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Purpose To assess the literature on the effects of topical intraocular pressure (IOP)-lowering medications on the ocular surface. Ocular surface assessment in these patients is seldom a priority for most clinicians since the ultimate goal of management is to preserve vision. Methods A literature search of articles (English only) on the subject matter was conducted and their findings summarized. Results This review assesses the prevalence of dry eye symptoms in glaucoma patients on topical IOP-lowering medications. We extensively reviewed the effects of the preservatives and active ingredients in these medications on the ocular surface. In particular, the effects of benzalkonium chloride (BAK), a widely used preservative, on meibomian glands are explored. Also mentioned in this review is the association between duration of therapy and severity of dry eye symptoms. The role of the pH of medications in the development of ocular surface disease is also reviewed. Finally, we probed the occurrences of ocular allergic reactions with the use of topical IOP-lowering medications. Conclusions The preservatives and active agents in most topical glaucoma medications are implicated in the prevalence of ocular surface discomfort. Whilst clinicians involved in glaucoma care are encouraged to assess the ocular surface routinely, further studies are needed to demonstrate the contributions of other physiochemical properties of these medications to the development of ocular surface disease in these patients.

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“…A notable limitation in this approach is that long-term use of topical anti-glaucoma medications increases the risk of developing ocular surface diseases [1–5]. Several previous studies have shown that the high incidence of dry eye, as well as the deterioration of ocular parameters and meibomian gland dysfunction (MGD) in glaucoma patients using IOP-lowering eyedrops is associated with the use of topical anti-glaucoma medications [6–10]. Previously, we also reported that glaucoma patients using topical anti-glaucoma medications showed deterioration of ocular surface status, including reduction in the thickness of the tear lipid layer [11].…”

Section: Introductionmentioning

confidence: 99%

“…Meibomian gland (MG) condition in glaucoma patients is related to the behaviors involved in medication use, such as frequency and duration, as well as the type of preservative and active ingredient in the medication [6,7,9,10,12]. Among several active ingredients used as topical anti-glaucoma medications, prostaglandin analogues (PGAs) are known to be associated with development of MGD [8,9,13–15].…”

Section: Introductionmentioning

confidence: 99%

Meibomian gland dropout rate as a method to assess meibomian gland morphologic changes during use of preservative-containing or preservative-free topical prostaglandin analogues

et al. 2019

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Purpose To investigate the usefulness of meibomian gland (MG) dropout rate in the evaluation of MG morphological change associated with the use of prostaglandin for glaucoma treatment through the association between MG and the ocular surface parameters and medication duration and presence of preservative. Methods This cross-sectional study was conducted on 88 eyes of 88 patients who were diagnosed with glaucoma and used only Tafluprost as treatment. The patients were divided into four “user” groups: 1) 23 patients used preservative-free (PF) Tafluprost for 6 months; 2) 21 patients used preservative-containing (PC) Tafluprost for 6 months; 3) 23 patients used PF-Tafluprost for 24 months; 4) 21 patients used PC-Tafluprost for 24 months. Ocular surface parameters and the MG condition, including MG dropout rate and meiboscale, were evaluated. Multiple regression was used to identify associations. Results There were significant differences in age (p = 0.003), tear breakup time (p = 0.016), lid margin abnormality (p = 0.016), expressibility (p = 0.039), meiboscale (p<0.001), and MG dropout rate (p<0.001) among the 4 groups. MG dropout rate and meiboscale showed significant differences in all post hoc analyses, except for the comparison between the PF-Tafluprost and PC-Tafluprost 6-month user groups. Medication duration, preservative status, and meiboscale were significantly correlated with MG dropout rate (p<0.001, p = 0.024, p<0.001, respectively). In the 6-month user group, preservative status significantly correlated with MG dropout rate (p = 0.015). However, in the 24-month user group, meiboscale was the only parameter significantly associated with MG dropout rate (p<0.001). Conclusion MG dropout rate in patients using Tafluprost showed a significant correlation with medication duration and preservative status. This result indicates MG dropout rate reflects MG morphologic change associated with prostaglandin.

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Meibomian Gland Performance in Glaucomatous Patients With Long-term Instillation of IOP-lowering Medications

Abstract: Patients with a higher BAG agents had more unstable tear films and more severe MG dropout. Therefore, MG disease should be particularly observed in patients with glaucoma following a higher BAG regimen.

Cited by 15 publications

References 33 publications

Characterization of the ocular surface temperature dynamics in glaucoma subjects using long-wave infrared thermal imaging

Characterization of the ocular surface temperature dynamics in glaucoma subjects using long-wave infrared thermal imaging

The impact of topical intraocular pressure lowering medications on the ocular surface of glaucoma patients: A review

Meibomian gland dropout rate as a method to assess meibomian gland morphologic changes during use of preservative-containing or preservative-free topical prostaglandin analogues

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