Characterization of Glaucoma Associated Dry Eye – Comparison of Patient Sub-Populations

Abstract

Purpose : Dry Eye disease (DED) is a multifactorial condition with varied presentation typically classified as aqueous deficient, evaporative or mixed. Topical glaucoma therapy can cause DED as a side effect that can adversely impact compliance and glaucoma treatment outcomes. Understanding the typical presentation of DED in glaucoma patients may enhance awareness, further understanding of DED pathophysiology and improve appropriate treatment interventions. Here we measured a panel of DED symptoms and signs in patient subpopulations of control eyes, Sjogren syndrome (SS), non-Sjogren autoimmune conditions (nonSS), and patients using topical glaucoma medications (Glc).

Methods : All patients completed a medical and ophthalmic history. All patients underwent testing including the Ocular Surface Disease Index (OSDI) questionnaire and a panel of DED measures including fluorescein tear break up time (TBUT), anesthetized Schirmer’s tear test (STT), tear osmolarity (TOsm) measure, and corneal Rose Bengal staining (RBS) graded using the oxford scale.

Results : 29 patients (48 eyes) were recruited for analysis: 12 eyes with SS, 16 eyes with non-SS, and 12 Glc eyes, and 18 control eyes (i.e., without any history of dry eye, autoimmune conditions or glaucoma).

Glc patients had statistically higher OSDI scores compared to control eyes, similar to the elevations observed in the SS and non-SS groups. Glc patients also had normal TBUT, Tosm, and RBS. Glc patients also had statistically higher STT (table 1).

Conclusions : Patients on topical antiglaucoma regimens frequently have DED symptoms with similar severity to other well-defined populations at risk for dry eye as defined by OSDI.

Despite symptoms, however, Glc patients had normal or better than normal DED clinical parameters, suggesting Glc patients may have neither aqueous deficient nor evaporative DED. Rather, unique underlying pathophysiologic mechanisms may be present in Glc patients.

Further work is necessary to confirm these findings and determine what role other pathophysiologic mechanisms (e.g., neuropathic pain) might play in causing the observed differences.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.