Ocular surface alteration after long-term treatment with an antiglaucomatous drug

Ophthalmology. 1992 Jul;99(7):1082-8. doi: 10.1016/s0161-6420(92)31847-0.


Background: This study was undertaken to see whether long-term locally applied ocular medications produced any alterations in the ocular surface, and, in particular, whether it caused damage to the mucus layer of the tear film.

Methods: The authors studied the ocular surface of 40 control subjects (group 1), 21 patients (group 2) chronically treated with a commercial preparation of 0.5% timolol maleate, and 20 previously untreated glaucomatous patients (group 3) in need of treatment with the same drug. Parameters studied were Schirmer's test, lacrimal meniscus height, break-up time, fluorescein and rose Bengal stains, conjunctival impression cytology, mucus staining, and the ferning test.

Results: Patients in groups 2 and 3 showed a significant decrease (P less than 0.001) in the number of normal Schirmer's and break-up time tests. All had positive vital stains. Results showed a significant decrease (P less than 0.001) in goblet-cell density, mucus granules, and reticular sheets, and an increase (P less than 0.001) in pathologic crystallization patterns.

Conclusion: These results demonstrate that chronic application of a commercial preparation of timolol maleate damaged the ocular surface, especially the mucus layer of the tear film.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Adult
  • Aged
  • Aged, 80 and over
  • Conjunctiva / drug effects
  • Conjunctiva / pathology
  • Cornea / drug effects*
  • Cornea / pathology
  • Female
  • Glaucoma, Open-Angle / drug therapy*
  • Glaucoma, Open-Angle / pathology
  • Humans
  • Lacrimal Apparatus / drug effects
  • Lacrimal Apparatus / pathology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mucus / drug effects*
  • Tears / cytology
  • Tears / drug effects
  • Timolol / administration & dosage
  • Timolol / adverse effects*


  • Timolol