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The Glaucoma-Dry Eye Connection

Friday, September 03, 2010


Glaucoma is the leading cause of preventable blindness, and it is the leading cause of blindness in both the African-American and Hispanic populations.

In the very early stages of glaucoma, dry eyes may be the only symptom.

Peer-reviewed studies suggest that primary open-angle glaucoma, but not ocular hypertension, can be associated with impaired basal (non reflex) tear turnover. Basal tear turnover values have been found to decrease with the increasing vertical or horizontal optic cup/disk ratios associated with glaucoma. Therefore, dry eye complaints should never be ignored since they could be associated with tear film deficiencies caused by unidentified open-angle glaucoma.

A surprising number of studies also suggest that lower basal tear turnover, decreased tear breakup times (TBUT), smaller values in Schirmer\'s, and higher distribution in the scores of Rose Bengal staining in glaucoma patients who use beta blocker eye drops (glaucoma prescription meds) for more than a few months.

A 2007 British Journal of Ophthalmology study suggests that pro-inflammatory cytokine secretion by conjunctival cells is increased in response to topical treatments for glaucoma.

A recent review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertension suggests that preservative free glaucoma drops can reduce some of the adverse effects.

These study results clearly support the need for careful consideration of all dry eye complaints, as well as the need to address dry eye and ocular surface potential side effects when writing scripts for most glaucoma prescription eye drops.

Ellen Troyer, MT MA - Biosyntrx CEO / Chief Research Officer
 

 

PEARL

These studies suggest that glaucoma patients need careful monitoring for symptoms of dry eye syndrome that could lead to ocular surface and possible corneal damage if not properly treated.  The bottom line: never gnore dry eye symptoms or complaints.

The Biosyntrx founders, staff and scientific advisory board wish for our Friday Pearl readers a safe and fun-filled Labor Day Weekend.

Crestpoint Management, LTD instrument announcement:
DK Open Blade Adjustable Speculum 9-579-6

References

Optic disk size and glaucoma. Hoffmann EM, Zangwill LM, et al. Surv Ophthalmology, 2007 Jan-Feb;52(1):32-49 [abstract]

 

Decreased basal tear turnover in patients with untreated primary open-angle glaucoma. Kuppens EV, van Best JA, et al. Am J Ophthalmol. 1995 Jul; 120(1): 41-6 [ abstract]

 

A review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertention. [abstract]

 

Adverse effects of topical antiglaucoma drugs on the ocular surface. Ariel MK, Ariel DS. et al. Clin Experimen Ophthalmol. 2000 Apr; 28(2): 113-7 [ abstract]

 

Changes in ocular surface caused by antiglaucomatous eyedrops: prostective, randomised study for the comparison of 0.5% timolol vs 0.12% unoprostone. Shimazaki, J, Hanada K, et al. Br J Ophthalmol Nov. 2000; 84: 1250-1254 [ abstract]

 

Measurement of inflammatory cytokines by multicytokine assay in tears of patients with glaucoma topically treated with chronic drugs. Malvitte L, Montange T, el al Br J Ophthalmol 2007 Jan;91(1):29-32 [abstract]