Abstract
Purpose: :
The purpose of this study was to evaluate the impact of conjunctivochalasis (CCh) severity on the ocular surface parameters of glaucoma subjects treated with topical antiglaucomatous medication.
Methods: :
One hundred patients with the clinical diagnosis of glaucoma were recruited for this prospective study undertaken at a single academic unit. CCh was graded based on the extent of inferior lid margin involvement as follows: 1=Single (temporal) location, 2=Two locations (nasal and temporal) and 3=Whole lid. For all subjects, the break-up time (BUT), Schirmer test (under topical anesthesia) and lissamine green (LG) staining was performed for both eyes. LG staining was graded in accordance with the Oxford grading system. Ocular surface disease index (OSDI) questionnaire scores were also noted for each subject. Student’s t-test, Mann-Whitney U test and Kruskal-Wallis test was used for statistical evaluations.
Results: :
Sixty-three subjects (mean age=67.1±9.3 years; glaucoma duration=11.8±7.3 years) had evidence of CCh; 32 had grade 1, 24 had grade 2 and seven had grade 3 CCh. Thirty seven glaucoma patients with a mean age=64.9±11.8 years and glaucoma duration of 11.9±7.6 years had no evidence of CCh. The mean age (p=0.299) and glaucoma duration (p=0.924) of patients with CCh was not significantly different from those without CCh. There were significant differences in the BUT scores (7.2±2.7s vs. 10.1±2.4s, p<0.001), Schirmer values (7.7±3.9mm vs. 13.3.±4.0mm, p<0.001), LG staining score (1.6±1.0 vs. 0.3±0.5, p<0.001) and the OSDI scores (19.4±17.2 vs. 6.7±5.2, p<0.001) between patients who had CCh and those without CCh. The BUT scores and Schirmer test values of patients with grade2&3 CCh were significantly lower than those of grade 1 CCh and those without CCh (p<0.001). The LG grading and OSDI scores were significantly higher in grade 2&3 patients as compared to those with grade 1 CCh and those without CCh (p<0.001). For all ocular surface parameters evaluated, there were no statistically significant differences between patients who were on one versus two medications.
Conclusions: :
The functional characteristics of the ocular surface appear to be adversely influenced by the presence and the extent of CCh in glaucoma patients.
Keywords: cornea: tears/tear film/dry eye • conjunctiva • ocular irritants