Glaucoma therapy and ocular surface disease: current literature and recommendations

Curr Opin Ophthalmol. 2013 Mar;24(2):136-43. doi: 10.1097/ICU.0b013e32835c8aba.


Purpose of review: To provide an update on clinical and experimental literature for ocular surface effects of glaucoma therapy and to provide practical guidelines for ophthalmologists treating glaucoma patients with ocular surface disease (OSD).

Recent findings: Preservatives, notably benzalkonium chloride (BAK), continue to contribute to OSD and demonstrate a variety of toxic ocular effects both in-vitro, and in animal/human studies. Recent literature frequently compares BAK with Polyquad, SofZia, and preservative-free therapies. Some clinical benefit has been demonstrated with newer BAK-free alternatives.

Summary: BAK-free and preservative-free therapies are becoming available but are not always a feasible alternative. It is important to recognize different clinical manifestations of allergy and chronic inflammation and to discuss options for patients experiencing OSD.

Publication types

  • Review

MeSH terms

  • Animals
  • Antihypertensive Agents / therapeutic use*
  • Benzalkonium Compounds / adverse effects
  • Conjunctival Diseases / chemically induced
  • Conjunctival Diseases / prevention & control*
  • Corneal Diseases / chemically induced
  • Corneal Diseases / prevention & control*
  • Dry Eye Syndromes / chemically induced
  • Dry Eye Syndromes / prevention & control*
  • Glaucoma / drug therapy*
  • Humans
  • Intraocular Pressure / drug effects*
  • Practice Guidelines as Topic
  • Preservatives, Pharmaceutical / adverse effects


  • Antihypertensive Agents
  • Benzalkonium Compounds
  • Preservatives, Pharmaceutical