Glaucoma Patients Experience Worse Dry Eye, Report Says

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Signs, symptoms, and severity of dry eye were all elevated among patients who used topical hypotensive medications for glaucoma.

If patients with glaucoma develop dry eye disease (DED), it is frequently more severe than it is for patients without glaucoma, according to a study in BMC Ophthalmology.  Patients with glaucoma who use multidrops and multidose per day medications for glaucoma control have significantly lower tear break-up time (TBUT) and higher corneal staining than those who do not, according to the Ethiopia-based research.

The cross-sectional comparative study, designed to determine the frequency of signs and symptoms and severity of DED in glaucoma patients on topical hypotensive medications and controls, looked at 320 patients and controls (160 had glaucoma). To assess DED, researchers used the Ocular Surface Disease Index (OSDI) symptoms score and Schirmer, TBUT, and corneal staining tests.

Corneal staining and TBUT scores were statistically significant between patients with and without glaucoma. Abnormal corneal staining was detected in 66% of glaucoma patients, but only 50% of patients without glaucoma (P =.045). TBUT was abnormal in 49% of patients with glaucoma and 45% of patients without glaucoma, (P =.021). Corneal staining and TBUT also demonstrated correlations with the number of drugs patients used (P =.004 and P =.031, respectively), and with the total number of drops patients applied each day (P =.01 and P <.001, respectively). Schirmer testing was also abnormal in 57% of patients with glaucoma patients and 52% of those without it, (P =.242). 

In particular,  pilocarpine and timolol affected ocular surfaces, the analysis found. These therapeutics were associated with more corneal staining and lower TBUT. 

The study’s main limitation was that everyone involved on drops used ones with benzalkonium chloride (BAC) preservative (an additional risk factor for DED), so “the effect of preservative-free drugs was not seen in this study.”


Sahlu M, Giorgis AT. Dry eye disease among glaucoma patients on topical hypotensive medications, in a tertiary hospital, Ethiopia. BMC Ophthalmol. Published online March 30, 2021. doi:10.1186/s12886-021-01917-3