Abstract
Purpose :
Glaucoma is known as the leading cause of irreversible blindness. Lowering the intraocular pressure (IOP) is a measure to prevent optic disc damage and disease progression, topical treatment represents keypoint of treatment as much as hazard source to the ocular surface homeostasis. The chronic use of glaucoma eyedrops causes proinflammatory responses, ocular surface dysfunction and discomfort symptoms in up 50% of patients and may deeply affect treatment compliance. This study aims to evaluate OSD in glaucoma, correlations with the number of drops, benzalkonium chloride (BAK), and the impact of OSD intensive treatment.
Methods :
Glaucoma patients with no previous ocular surface pathologies were included in this study.
The evaluation consisted in: ocular surface disease index (OSDI) questionnaire, a non-invasive objective assessment of the ocular surface and photographic documentation (Keratograph 5M), ocular surface staining with fluorescein and lissamine green, Schirmer test, and IOP measurements. OSD treatment consisting of eyelid hygiene twice day, fluorometholone acetate 0,1%, preservative-free lubricant every 2 hours, fatty acid supplementation, and oral doxycycline 100 milligrams per day along with glaucoma topical medications.
Results :
Nineteen patients were evaluated pre and post-treatment, 11 women and 8 men. The median age was 70 ± 9.79 years. Regarding IOP-lowering drops, the number of drops per day was of 5 ± 1.90, 3 ± 1.17 medications containing BAK as preservative. The median duration of glaucoma topical treatment was of 56 ± 26.27 months.
73,7% of the patients had an OSDI score higher than 33, FBUT was graded as level 2 in 50% of the patients, corresponding to 1-4 seconds for the first break to be identified, while the Schirmer test was > 10 mm, in 76,5%. Meibomian gland dysfunction was found in 56,2% of the patients, some with severe meibomian gland abnormalities. Both fluorescein and lissamine green staining of the ocular surface were graded as level 2 in the majority of the patients. After treatment, improvement of symptoms and ocular surface parameters were observed in best-corrected visual acuity, OSDI score, bulbar redness and fluorescein staining of the ocular surface, as well as IOP measurements.
Conclusions :
OSD signs and symptoms represent a challenge in glaucoma patients. Treatment can improve ocular surface parameters and symptoms improving compliance and the IOP control.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.