This article was originally published in a sponsored newsletter.
A significant number of patients who use topical medications to manage their glaucoma deal with ocular surface diseases, especially dry eye disease (DED). Even so, DED is not always taken seriously or given the respect it deserves. As a cornea specialist, I see many of these patients. I’ve had patients with corneal erosions, ulcers, cicatrizing conjunctivitis, and many other issues related to chronic topical glaucoma medications. It’s important to remember the significant impact that DED can have on patients’ quality of life, occupational needs, and consistency and clarity of vision.
When glaucoma patients with DED end up in my office, it can be complicated to pull from our armamentarium. There is no simple treatment option for glaucoma patients.
Most commonly, we turn to artificial tears. However, many of these patients have at least some level of neurotrophic keratitis, which means they might be dry but are not aware of it. That may keep them from using the artificial tears as often as they should.
Steroids are a challenging option because they can raise intraocular pressure.
We might turn to anti-inflammatory options such as cyclosporine, but those medications add to patients’ medication burden, often resulting in decreased compliance. There have also been some issues with tolerance of these types of medications. Further, patients may want to administer all their drops at once, but using a medication like cyclosporine at the same time as a glaucoma drop will likely reduce or dilute the effect of the other.
In short, while we have medication options, they are complicated.
When I work with glaucoma specialists, I talk with them about what we can do to improve patients’ vision, comfort, and quality of life. The easiest change is to switch to preservative-free glaucoma drops. If the patient qualifies, I also like to discuss selective laser trabeculoplasty and micro-invasive glaucoma surgery to reduce medication burden and improve the ocular surface because procedures such as stenting can uncomplicate things. DED glaucoma patients who have undergone stenting may be on fewer or no glaucoma medications, and often, stenting alone helps their ocular surface heal.
While many people see DED as innocuous, as a cornea specialist, I can attest that is simply not the case. We must avoid creating ocular surface issues that are not easily reversed. The first line really is with glaucoma specialists who can keep ocular surface health in mind as they aim to modify, reduce, or eliminate drops.
