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Teresa Rolle, Daniela Curto, Elena Isaia, Francesco Damiani, Pietro Lanzafame, Alessandro G. Actis; Ocular Surface Alteration and Topical Antiglaucomatous Therapy: Symptoms vs Clinical Signs. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1964.
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To evaluate the ocular surface disease in glaucomatous and ocular hypertensive patients treated with IOP-lowering drugs with preservative (benzalconium chloride) and to analyze the correlations between symptoms and clinical signs.
This was a prospective observational study. 106 consecutive patients with open angle glaucoma or ocular hypertension were enrolled in the study. Each patient completed the Ocular Surface Disease Index questionnaire; Schirmer test, tear break-up time and lissamine green staining of the conjunctiva were performed. For each patients we considered the eye that showed worse results for each test. A multivariate regression analysis was used to investigate the relationship between OSDI and clinical tests, OSDI and the number of antiglaucomatous drugs. Χ 2 test was used to evaluate the correlation between OSDI and the duration of treatment. P values < 0.05 were considered significant.
102 patients (96,2%) reported symptoms in at least 1 eye; 24 (22.6%) mild to moderate; 78 (73,6%) severe. OSDI score was related with the number of drugs used (p<0.01). No correlations were found with the duration of treatment. Schirmer test was altered in 89 patients (84%): 57 patients (53.8%) showed a mild- moderate decrease in tear production and a severe deficiency was observed in 32 patients (30,2%). Tear break-up time was reduced in 80 (75.5%) patients: mild to moderate in 71 (67%) and severe in 9 (8.5%). Conjunctival lissamine green staining showed positive results in 60 (56.6%) patients: mild to moderate in 46 (43.4%) and severe in 14 (13.2%). Agreement on the results of the 3 clinical tests was obtained in 43 patients (40.6%) followed by tear break-up time and Schirmer test in 30(28.3%). Poor correlation was observed between symptoms and clinical signs: a significant correlation was found only for OSDI vs Schirmer test (p<0.05).
A large number of glaucomatous and ocular hypertensive patients had an abnormal OSDI and the score increases with the greater the number of glaucoma drugs prescribed. A large proportion of patients who had a severe OSDI had a normal or mild to moderate alterations of clinical tests. It can be assumed that other factors (psychological, environmental , severity and awareness of the disease…) can influence OSDI.
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