Abstract
Objective:To evaluate the incidence of ocular surface disease (OSD) and to determine the effects of topical pressure-lowering drugs on ocular surface disease in primary angle closure patients.Methods:This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer’s test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses.Results:Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer’s test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer’s test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer’s test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference.Conclusion:Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients.
Highlights
Ocular surface disease (OSD) is defined as a group of ocular disorders that affect various component of the ocular1874-3641/17 2017 Bentham Open.32 The Open Ophthalmology Journal, 2017, Volume 11 surface [1]
Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer’s test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer’s test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer’s test
Ocular surface disease is common in primary angle closure glaucoma (PACG) patients treated with topical pressure-lowering drugs
Summary
Ocular surface disease (OSD) is defined as a group of ocular disorders that affect various component of the ocular1874-3641/17 2017 Bentham Open.32 The Open Ophthalmology Journal, 2017, Volume 11 surface [1]. OSD is due to increased tear osmolarity, inflammation and disruption of the ocular surface [1, 2]. Risk factors for OSD include the elderly, women especially menopausal women, the Asian population, multiple systemic comorbidities and ocular diseases [3 - 8]. Chronic use of topical ophthalmic solutions is another major contributing factor in OSD [9]. OSD may be induced by topical pressure-lowering agents through chronic toxicity to the preservatives especially benzalkonium chloride (BAK) and active ingredients, alteration of the tear film stability and direct injury to the ocular epithelial surface [11, 12]. The majority of glaucoma patients require multiple medications to achieve the target pressure for a long period, and this further increases the risk for OSD [13 - 15]
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