Preserved medications may have detrimental effects in glaucoma patients with concurrent OSD

Ocular surface disease (OSD) in patients with glaucoma is surprisingly common, yet it remains an under-recognized condition by eye-care specialists. Among patients with severe OSD, approximately two-thirds concurrently are afflicted with glaucoma (range, 42.9% to 88.4%).¹ OSD encompasses a myriad of ocular conditions, including keratoconjunctivitis sicca.

This discussion will examine the most current information regarding OSD in the patient with glaucoma, emphasize the importance of accurately identifying these patients, and offer management strategies, including the use of preservative-free preparations that can be incorporated easily into any practice. Minimizing preservative exposure will respect the cell biology of the corneal surface, the conjunctival surface, and the corneal endothelium, as well as the trabecular meshwork. The result will be increased patient comfort, compliance, vision, and maximized positive clinical outcomes, including those in post-surgical patients.

OSD in glaucoma patients

Dry eye, one of the most common forms of OSD, remains an under-recognized clinical manifestation in patients with glaucoma. Artificial tears often are prescribed without a full examination in patients with glaucoma who complain of dry, red, itchy eyes.

Although a variety of factors may contribute to either the development or exacerbation of OSD, the chronic application of preserved medications, particularly those containing BAK directly to the ocular surface in the population of patients with concurrent OSD and glaucoma, is a major concern. This practice can exacerbate the development and severity of the underlying OSD.

Preservatives are important components of ophthalmic solutions, but they certainly are the epitome of the double-edged sword. BAK is the most widely used preservative in ophthalmic preparations, including prostaglandin analogues, first-line drugs used in the management of glaucoma, as well as other IOP-lowering drugs, artificial tears, and antibiotics.