Glaucoma and Dry Eye Disease: Opportunity to Assess and Treat

Abstract

Dry eye disease (DED) has been found to occur at a higher prevalence in individuals with glaucoma than in individuals without glaucoma. The relationship between glaucoma and DED may be, in part, a result of glaucoma therapy. Greater number of antiglaucoma medications used and greater number of antiglaucoma eyedrops instilled per day have been associated with ocular surface disease in patients with glaucoma. Use of antiglaucoma medication has also been associated with higher levels of ocular surface inflammatory markers and ocular surface alterations. There is evidence to suggest that antiglaucoma medications with preservatives and, to some extent, antiglaucoma medication formulations without preservatives may contribute to ocular surface signs and symptoms. Trabeculectomy for glaucoma has also been associated with ocular surface signs related to DED; however, there may be benefits of trabeculectomy and other procedures for glaucoma due to reduced use of antiglaucoma medications. Patients with glaucoma with ocular surface disease have been found to have greater ocular surface symptoms, poorer vision-related quality of life, and poorer antiglaucoma medication adherence compared with patients with glaucoma without ocular surface disease. Because of the potential negative impact of DED on patients with glaucoma, patients with glaucoma may benefit from evaluation for DED. Management of DED in patients with glaucoma may include modifications to antiglaucoma medications and use of treatments for DED.

Keywords:

• ocular surface
• quality of life
• antiglaucoma medication
• inflammation
• preservatives

Abbreviations

BAK, benzalkonium chloride; DED, dry eye disease; DEQ-5, Dry Eye Questionnaire – 5 item; GQL-15, Glaucoma Quality of Life-15; IDEEL, Impact of Dry Eye on Everyday Life; IL, interleukin; IOP, intraocular pressure; MGD, meibomian gland dysfunction; MIGS, minimally invasive glaucoma surgery; MMP-9, matrix metalloproteinase 9; NEI-VFQ 25, National Eye Institute-Visual Function Questionnaire; OR, odds ratio; OSDI, Ocular Surface Disease Index; Th, T helper.

Acknowledgment

Medical writing support was provided by Ann E. Todd (IMPRINT Science, New York, NY) and was funded by Novartis Pharmaceuticals Corporation. Inder Paul Singh contributed to conceptualizing and critically reviewing this work. This manuscript was developed in accordance with Good Publication Practice (GPP3) guidelines. Authors had full control of the content and made the final decision on all aspects of this publication.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Lisa M Nijm, MD, JD, has been a consultant/advisor for Aerie Pharmaceuticals, Alcon Laboratories, Allergan, Bausch + Lomb, Bruder Healthcare Company, Carl Zeiss Meditec, CooperVision, Dompe, Horizon, Johnson & Johnson Vision, Novartis, Ocular Therapeutix, Rayner, Oyster Point, Sun Ophthalmics, TearLab Corporation, Thea Pharmaceuticals; has received lecture fees and/or has been on a speaker bureau for Allergan, Bausch + Lomb, Oyster Point, Sun Ophthalmics; and holds equity/stock in TearLab Corporation. Justin Schweitzer, OD, has received relevant honoraria for consulting and speaking on the subject matter from Allergan, Glaukos, Novartis Pharmaceuticals Corporation, Sun Ophthalmics, and Quidel. Jennifer Gould Blackmore, OD, has received relevant honoraria for consulting and speaking on the subject matter from Aerie Pharmaceuticals, Bausch + Lomb, and Allergan. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.