Ocular Surface Disease Signs and Symptoms in Patients with Pseudoexfoliative Glaucoma: A Case-Control Study.

Maria Dermenoudi,Christina Keskini,Artemis Matsou,Eleftherios Anastasopoulos

doi:10.3390/vision6010011

Abstract

Purpose: The present study evaluates the differences in the prevalence of the signs and symptoms of ocular surface disease (OSD) in patients with PEX glaucoma (PEXG), compared to other glaucoma types (non-PEXG). Methods: Patients with non-PEXG and PEXG were prospectively examined for the presence and severity of OSD signs and questioned for symptoms using the OSDI (ocular surface disease index) questionnaire. Results: 116 patients were prospectively enrolled (58 non-PEXG and 58 PEXG). PEXG subjects who were older, had lower central corneal thickness (CCT) values, at a more advanced glaucoma stage and required more IOP lowering drops. OSD signs were prevalent in both groups: conjunctival hyperemia (74.5% non-PEXG vs. 94.8% PEXG), eyelid redness (70.7% vs. 96.6%), conjunctival (74.1% vs. 93.1%) and corneal fluorescein staining (81% vs. 93.1%) and abnormal TFBUT (82.8% vs. 87.9%). When adjusted for potential confounders, (older age, thinner CCT, more advanced glaucoma in PEXG) eyelid redness remained the only parameter significantly associated with PEXG, being 11 times more likely to occur in this group (p = 0.037). Conclusion: Subjects with PEXG presented a higher frequency of signs of OSD compared to other glaucoma types. When accounting for confounding factors, the only difference between the groups was the significantly higher presence (11 times more likely) of eyelid redness in PEXG, suggesting, in addition to glaucoma treatment, the impact of PEX on ocular surface integrity.

Highlights

Pseudoexfoliation (PEX) syndrome is considered the most identifiable cause of secondary open angle glaucoma [1], characterized by the gradual accumulation and deposition of a whitish fibrillar substance of unknown origin, most notably in intraocular anterior segment structures, such as the anterior lens capsule, iris and pupillary margin, iridocorneal angle, zonules, ciliary body and corneal endothelium [2]
In order to evaluate the subjective severity of dry eye symptoms, we provided our patients with the ocular surface disease index (OSDI) questionnaire at the beginning of the consultation
Pseudoexfoliative glaucoma was identified in 58 (50%) subjects, while 58 had other types of glaucoma; of the latter group, the majority presented with POAG (n = 40), 8 with ocular hypertension (OH), and the remaining with normal-tension (NTG), pigmentary (PG) and chronic closed-angle glaucoma (CCAG)

Summary

Introduction

Pseudoexfoliation (PEX) syndrome is considered the most identifiable cause of secondary open angle glaucoma (pseudoexfoliative glaucoma, PEXG) [1], characterized by the gradual accumulation and deposition of a whitish fibrillar substance of unknown origin, most notably in intraocular anterior segment structures, such as the anterior lens capsule, iris and pupillary margin, iridocorneal angle, zonules, ciliary body and corneal endothelium [2] Extraocular tissues, such as conjunctival goblet cells and accessory lacrimal glands, appear to be affected by PEX deposition, as demonstrated in conjunctival biopsies and impression cytology studies [3,4,5,6]. Preservatives contained in glaucoma eye drops, with benzalkonium chloride (BAK) being the most widely used, have long been accused of provoking or aggravating OSD, mainly through corneal epithelial toxicity, conjunctival squamous metaplasia, loss of goblet cells, ocular surface inflammation and tear film disruption [12]

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