Changes of the bulbar conjunctiva as the result of glaucoma medication treatment

Abstract

Aims/Purpose: To determine changes of the bulbar conjunctiva as the result of glaucoma medication treatment.Methods: We used an impression cytology method which implies the application of a cellulose acetate filter to the ocular surface, twice in the same place, to remove superficial layers of the nasal quadrant conjunctiva epithelium. The strips were removed after a few seconds of exposure, transferred into a fixative solution, followed by histological staining and light microscopy examination. The presence of squamous metaplasia was assessed using Nelson's scale, based on cells' morphology, staining behaviour, integrity and nucleoplasmic ratio. The case study included the first group of patients suffering from POAG and DED (80) (mean age = 63.8 ± 6.7 years) which was divided into 4 subgroups: 1 ‐ patients (40), who suffer from glaucoma for less than 5 years; 2 (40) ‐ more than 5 years; subgroup a (40) ‐ with one drug instilled, b (40) ‐ 2 or more drugs instilled. The second group consisted of almost healthy patients (mean age = 67.9 ± 8.9 years) All of them underwent general ophthalmological examination.Results: According to OSDI all glaucoma patients had dry eye symptoms (15 or more points). In subgroup 1 40% were diagnosed with Nelson I, 60% with Nelson II. In subgroup 2 15% had Nelson I, 55% had Nelson II and 30% had Nelson III. In subgroup a 20% of patients had Nelson I, 60% had Nelson II, and 20% were diagnosed with Nelson III. In subgroup b 30% had Nelson I, 60% had Nelson II, 10% of patients had Nelson III.Conclusions: 80% of cases show changes that correspond to II‐III Nelson degrees according to Nelson classification. The severity of metaplasia correlated with the duration of eye drops therapy, but not with the amount of them. According to the results that we received, and the international data, it is recommended to choose drugs without preservatives and other potentially toxic components for the long‐term treatment of glaucoma.