New Strategies for the Management of Ocular Surface Disease in Glaucoma Patients

Laura Voicu; Sarwat Salim


Curr Opin Ophthalmol. 2021;32(2):134-140. 

In This Article

The Importance of Managing Ocular Surface Disease in Glaucoma Patients

Multiple studies have shown reduced compliance with increasing complexity of treatment regimen in glaucoma patients.[5] Adherence to glaucoma medications in the setting of concomitant OSD is further reduced, increasing the overall risk for glaucoma progression.[6] In a traditional glaucoma treatment model, disease progression is managed by addition of multiple medications, most of which contain preservatives. Adding topical drops for the treatment of dry eye in addition to multiple glaucoma drops may further complicate the co-management of these conditions. For these reasons, the development of effective, evidence-based diagnostic and treatment strategies for the management of OSD in patients with glaucoma, including interventions that may reduce drop burden, are needed.

There are additional considerations regarding the importance of controlling OSD and optimizing surgical outcomes after glaucoma surgery. It is well established that subconjunctival inflammation and fibrosis occur with chronic use of preservative-containing glaucoma medications, and these may reduce the success of subsequent glaucoma surgery.[7] Infections are also more frequent in patients with uncontrolled OSD who undergo glaucoma surgery.[8] A healthy ocular surface is also crucial for preoperative intraocular lens measurement accuracy and postoperative patient satisfaction.

The quality of diagnostic tests, including visual field and optical coherence tomography, has been reported to be affected in the presence of OSD. This can make medical and surgical decision making more difficult.[9,10] Furthermore, the most important consideration for the careful management of OSD in glaucoma patients is significant reduction of quality of life among patients with concomitant glaucoma and OSD.[11,12] While studies specifically addressing the management of OSD in glaucoma patients are lacking, application of new management strategies for OSD as well as the adoption of new glaucoma technologies offer us opportunities to address these challenges with a proactive, methodical approach.