Ocular Surface Disease in Patients under Topical Treatment for Glaucoma

Eur J Ophthalmol. 2017 Nov 8;27(6):694-704. doi: 10.5301/ejo.5000977.


Purpose: To examine the relationship between ocular surface disease (OSD) and topical antiglaucoma therapy.

Methods: A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication were recruited over 10 months. Controls were 51 eyes of 51 healthy age- and sex-matched volunteers. In each patient, we recorded the intraocular pressure-lowering eyedrops used, the number of medications used, and daily and cumulative preservative concentrations (PC). Main outcome measures were fluorescein corneal staining score (Oxford scale), lower tear meniscus height (LTMH) (spectral-domain optical coherence tomography), noninvasive tear film breakup time (NI-TBUT) (Oculus Keratograph 5M), and OSD symptom questionnaire index (OSDI).

Results: Compared to controls, significantly higher OSDI (median [interquartile range] 10.24 [4.54-18.94] vs 2.5 [0-12.5]; p<0.001) and corneal staining (≥1: 64.93% vs 32.61%; p<0.001) scores were recorded in the medication group. The NI-TBUT and LTMH failed to vary between the groups (p>0.05). A higher daily PC was associated with a lower LTMH (R -0.142; p = 0.043). In the medication group, multivariate analysis identified correlations between benzalkonium chloride (BAK) (odds ratio [OR] 1.56) and BAK plus polyquaternium-containing drops (OR 5.09) or higher OSDI (OR 1.06) and abnormal corneal staining test results and between older age (mean ratio [MR] 1.05), longer treatment duration (MR 1.02), or corneal staining presence (MR 1.22) and a higher OSDI score.

Conclusions: Ocular surface disease was more prevalent in the medication group. The main factors impacting OSD were drops with preservatives, longer treatment duration, and older age.

Keywords: Fourier-domain optical coherence tomography; Glaucoma medications; Keratograph 5M; Ocular surface disease.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / adverse effects*
  • Antihypertensive Agents / therapeutic use
  • Benzalkonium Compounds / adverse effects
  • Case-Control Studies
  • Cornea / metabolism
  • Cornea / pathology
  • Cross-Sectional Studies
  • Female
  • Fluorescein / metabolism
  • Glaucoma, Open-Angle / drug therapy*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Ocular Hypertension / drug therapy*
  • Ophthalmic Solutions / adverse effects*
  • Ophthalmic Solutions / therapeutic use
  • Preservatives, Pharmaceutical / adverse effects
  • Prospective Studies
  • Tears / metabolism
  • Tonometry, Ocular


  • Antihypertensive Agents
  • Benzalkonium Compounds
  • Ophthalmic Solutions
  • Preservatives, Pharmaceutical
  • Fluorescein