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

Advances in Procedural Management of Ocular Surface Disease

Given the potential challenges related to compliance and side effects when adding dry eye topical medications to a topical glaucoma regimen, procedures to treat OSD may be of particular interest in this patient population. Multiple devices have recently been developed to aid physicians in improving the quality of MGD through in-office procedures which may augment at-home remedies. Patients with MGD may benefit from thermal pulsation (e.g., LipiFlow, Johnson & Johnson Vision, Jacksonville, FL, USA) or Intense Pulsed Light (e.g., Optima IPL M22, Lumenis, Salt Lake City, UT, USA).[40] Thermal pulsation heats and massages the eyelid margins to liquefy and express gland secretions to improve flow. For patients with significant eyelid margin inflammation, such as those with ocular rosacea, including many patients on chronic glaucoma drops, IPL may be helpful. IPL works by thermal selective coagulation and ablation of superficial blood vessels and telangiectasias of the eyelid skin, reducing the release of inflammatory mediators and tear cytokine levels, and improving meibomian gland outflow. Manual gland expression may be performed after treatment. While studies are currently lacking on the efficacy of IPL or thermal pulsation in patients with evaporative dry eye with chronic glaucoma drop use, these treatments together with modification of drop regimen may be effective strategies.

Patients with glaucoma and OSD may have aqueous deficiency and dysfunctional tear film circulation. Recent studies have highlighted the utility of punctal plugs in treating these patients.[41,42] One randomized controlled study of punctal plug placement in glaucoma patients treated with a prostaglandin analog found reduced OSDI scores, increased tear break up time, reduced corneal staining, and reduced osmolarity. Interestingly, intraocular pressure was also reduced, presumably due to increased retention and absorption of prostaglandin.