SAN DIEGO — Treatment for glaucoma may be a leading cause of ocular surface disease, according to a speaker here.
“We understand that your [glaucoma] patients are at greater risk for ocular surface disease than non-glaucoma patients,” Edward J. Holland, MD, said at Glaucoma Day preceding the American Society of Cataract and Refractive Surgery meeting.
Edward J. Holland
“Your [glaucoma] patients are elderly, so they have decreased age-related tear secretion; they are on medications for life and frequently on many medications; and if they undergo some filtering procedures, that is a further insult to the ocular surface and the conjunctiva,” Holland said.
According to several studies, prevalence of ocular surface disease (OSD) ranges from 30% to 70% in all glaucoma patients, and glaucoma patients with OSD have a poorer quality of life, Holland said.
Risk factors for glaucoma are age, number of daily eye drops, disease severity and the duration of topical treatment, Holland said.
“How does glaucoma management make OSD worse? We understand the problems with benzalkonium chloride, and there is certainly a move in all medications to reduce the concentration and try and get it out of our drops,” Holland said.
In addition to the benzalkonium, Holland said that glaucoma medication, the use of antimetabolites in surgery and the trauma from the surgery all increase the incidence of OSD.
Holland advises colleagues to recognize signs of OSD.
“It is probably a good approach just to assume that the majority of your patients are going to have it [OSD]. We can do careful examination and start looking for lid anatomy and function. We want to look for exposure, lagophthalmos, blepharitis, blink rate, tear volume.”
Surgeons can treat OSD by treating aqueous deficiency, using anti-inflammatory topical agents, using therapeutic contact lenses, treating meibomian gland dysfunction and recognizing the signs of limbal stem cell deficiency, Holland said. – by Nhu Te
Disclosure: Holland reports financial interests with Alcon, Bausch + Lomb, Kala Pharmaceuticals, Mati Therapeutics, Nutriceuticals, Rapid Pathogen Screening, Senju Pharmaceuticals, TearLab and TearScience.