Ocular Surface Changes in Primary Open Angle Glaucoma Patients Treated With Topical Antihypertensive Drugs

Abstract

Précis: In this study, patients with glaucoma undergoing topical antihypertensive (TAH) drugs had changes in the ocular surface and more dry eye symptoms than controls. Clinicians should recognize the influence of TAH drops on exacerbating ocular surface disease. Purpose: The purpose of this study was to evaluate the ocular surface of eyes with glaucoma treated with TAH drugs. Methods: Cross-sectional study that included eyes undergoing TAH drugs due to primary open angle glaucoma and controls. The parameters evaluated were: the basal tear flow (basic secretion test); the tear film osmolarity (TearLab); and the noninvasive break-up time, blink score, lipid layer thickness, tear meniscus height, and loss area of the meibomian glands, measured with the IDRA Ocular Surface Analyser. Presence of symptoms [Ocular Surface Disease Index (OSDI)], dry eye disease (DED, TFOS DEWS II criteria), and corneal fluorescein staining were assessed. Results: We included 154 eyes (154 patients), 77 undergoing TAH drugs for glaucoma (group 1) and 77 of controls (group 2). The tear film osmolarity (P=0.003) and the loss area of the meibomian glands (P=0.004) were higher in group 1. The noninvasive break-up time (P=0.005), lipid layer thickness (P=0.006), and tear meniscus height (P=0.001) were lower in group 1. The global OSDI score (P<0.001), the proportion of eyes with severe disease (P=0.002), according to the OSDI, and with DED (P<0.001), according to the TFOS DEWS II criteria, were higher in group 1. The proportion of patients with corneal fluorescein staining was higher in group 1 (P<0.001). There were no significant differences in eyes taking TAH drugs with and without preservatives (P>0.127). Conclusions: DED, in patients with glaucoma, is a multifactorial disease, with a strong contribution from TAH drugs. These eyes had changes in almost every measured parameter, translating into the presence of more dry eye symptoms and corneal damage when compared with controls.