Ocular Surface Morbidities in Glaucoma

Abstract

Introduction: ocular surface disease (oSd) is a major cause of ophthalmological consultation. Within this group, glaucoma patients constitute an important percentage due to the nature of their chronic topical treatment. advances in the understanding of ocular surface pathology on both a cellular and molecular level, and the interaction to the toxic nature of some topical medication solution compounds, are stimulating the development of better alternatives in topical treatment. Materials and Methods: Extensive review of available literature and current research on topical ophthalmological treatments in both oSd and glaucoma was performed. Emphasis was made on inflammatory modulators of the ocular surface and pathological changes associated with the use of preservatives in solutions, in particular benzalkonium chloride (BaK). independent research is been also performed by the authors, using a rubbing-induced reflex tears collecting method with capillary tubes. cytokines in tear samples were subsequently analysed with the multi-Plex System (luminex ® R-200). The 12 cytokines analysed using this method are the interleukins (il)-1β, il-2, il-4, il-5, il-6, il-7, il-8, il-10, il-12, the tumour necrosis factor alpha (TNFα), the vascular endothelial growth factor (VEGF), the granulocyte-macrophage-colony stimulating factor (GM-cSF) and the interferon gamma (iFg). Results: our unpublished, preliminary results trend to show higher values in il-5 and il-6 in glaucoma patients than in normal controls. also, higher values in il-2, il-5 and il-12 in dry eye syndrome (dES) patients were found versus normal controls. Conclusions: inflammation is an important element in oSd and strong association seems to exist between this and the use of BaK preservative. New kinds of preservative molecules, as well as single-dose eye drops and sophisticated dispensing bottle mechanisms, are currently available on the market in order to avoid the secondary effects of this topical treatments, increasing patient compliance and adherence to chronic topical glaucoma treatment.

Cytokine expression in tears of patients with glaucoma or dry eye disease: A prospective, observational cohort study

“…It is not uncommon to see clinical manifestations of DED in patients chronically treated with IOP-lowering eye drops. It has been shown in some studies that 66% of patients with severe DED also have glaucoma, 8 and around 60% of patients with glaucoma receiving topical therapy report DED symptoms 9,10 that appear at the initiation of medical treatment. 11 These side effects may be triggered by the active compound, by the preservatives included in the formulation, or both.…”

A study of ocular surface disease in patients using topical antiglaucoma medication at a tertiary care centre

“…In our study, the mean count of goblet cells showed significant reduction by the end 12 month of study period, almost in all patients. The prevalence of OSD among users of preserved topical antiglaucoma medications was significantly higher than among nonusers as assessed by FTBUT (83.5% vs. 57.3%; P<0.001), Schirmer I (30.1% vs. 17.5%; P = 0.033), and ocular surface staining (62.1% vs. 31.1%; P<0.001) [1] .…”

“…Ocular surface disease (OSD) is a major cause of ophthalmological consultation [1] . Within this group, glaucoma patients constitute an important percentage due to the nature of their chronic topical treatment.…”

“…Just as with many eye drops, these medications generally contain preservatives to warranty their safety. Recent evidence has shown that some of the ingredients used as preservatives in many ophthalmic medications are at least partially responsible for the problem [1,2] . In particular, glaucoma patients, who are exposed to a chronic use of preservatives in their treatment, constitute a significant percentage.…”

“…In particular, glaucoma patients, who are exposed to a chronic use of preservatives in their treatment, constitute a significant percentage. It involves all sorts of pathological alterations of conjunctiva and cornea from the minor such as punctate keratitis, to the extreme such as symblepharon, or loss of limbal stem cells with corneal conjunctivalisation [1] . Within this group, dry eye syndrome (DES) constitutes a well-defined, multifactorial aetiology but clearly defined symptoms.…”