scholarly journals Ocular Surface Disease Signs and Symptoms of Glaucoma Patients and Their Relation to Glaucoma Medication in Finland

Author(s):  
Minna Parkkari ◽  
Petri Purola ◽  
Hannu Uusitalo

Abstract Purpose: To evaluate the prevalence of ocular surface disease (OSD) signs and symptoms of glaucoma patients in relation to topical glaucoma treatment and to compare them to non-glaucomatous population. Methods: A multicenter, cross-sectional study consisting of private ophthalmology clinic visits in southern Finland. Glaucoma patients had a diagnosis of primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma or treated ocular hypertension. Control patients had no prior or current use of glaucoma medication. Recorded parameters included OSD signs and symptoms, used glaucoma medications during the past 6 months, and the product name and type of used antiglaucoma drugs.Results: Glaucoma patients (n = 564) showed higher severity of OSD sign parameters excluding Schirmer’s test, as well as increased dry eye sensation compared to controls (n = 51). Beta-blockers and preservative-free prostaglandins had the smallest effect on all parameters. The increasing number of active compounds and administered eye drops per day showed an association with increasing severity of OSD signs and symptoms.Conclusion: Glaucoma patients show higher prevalence of OSD signs and dry eye sensation compared to non-glaucomatous population. The use of preserved glaucoma medication, as well as high number of active compounds and eye drops increase the severity of these parameters. There are significant differences between the types of glaucoma medication used, and therefore the selection of them is important especially in patients suffering from OSD.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miraf Sahlu ◽  
Abeba T. Giorgis

Abstract Background Dry eye disease is a multifactorial disease; causing various ocular symptoms with potential damage to the ocular surface. Applying hypotensive eye drops are presumed to initiate or exacerbate existing dry eye disease. The purpose of this study was to determine the frequency of signs and symptoms and severity of dry eye disease among glaucoma patients on topical hypotensive medications and controls. Methods A cross-sectional comparative study, involving 320 glaucoma patients and controls. Ocular Surface Disease Index (OSDI) symptoms score and Schirmer, tear breakup time and corneal staining tests were used to assess dry eye disease. Data was analyzed using SPSS version 24 software; p-value less than 0.05 was considered as statistically significant. Results Among the 160 study glaucoma patients, the mean duration of topical hypotensive medication use was 5.2 ± 5.21 years (range, 4 months - 32 years). Mild to severe level of OSDI score was found in 122 (76%) glaucoma patients and in 137 (86%) controls (p = 0.033). Mild to sever abnormal clinical tests in the glaucoma patients and control, respectively, were 106 (66%) vs 80 (50%) corneal staining (p = 0.045), 79 (49%) vs 72 (45%) TBUT (p = 0.021), and 91 (57%) vs 83 (52%) Schirmer test (p = 0.242). Test results at the level of sever: 2 (1%) vs 0 (0%) corneal staining, 50 (31%) vs 39 (24%) TBUT and 65 (41%) vs 60 (38%) Schirmer test in the glaucoma patents and controls, respectively. Corneal staining and TBUT had correlation with the number of drugs (p = 0.004 and 0.031, respectively), and more relationship of the two tests with total number of drops applied per day (p = 0.01 and p <  0.001, respectively). Patients on pilocarpine and timolol had more corneal staining and lower TBUT [(p = 0.011 and p <  0.001) and (p = 0.04 and 0.012), respectively]. Conclusions The study has identified glaucoma patients to be more affected by dry eye disease than non-glaucoma patients, and presence of significantly lower TBUT and higher corneal staining in the glaucoma patients on multidrops and multidose per day. We recommend consideration of evaluation and management of DED for glaucoma patients on multidrops and multidose hypotensive medications.


2021 ◽  
Vol 2 (2) ◽  
pp. 71-76
Author(s):  
Naser Nozari ◽  
Shahrokh Ramin

Background: The mainstay of dry eye treatment is artificial tear solutions. Contralateral eye comparison of 2 types of artificial tears (Xiloial versus Tearlose) in managing dry eye disease was sought in this study. Methods: This study was a prospective, interventional, contralateral eye comparison of 2 types of artificial tears used for managing dry eye disease. The study participants were categorized into mild (13–22 points), moderate (23–32 points), or severe (33–100 points) ocular surface disease according to the baseline ocular surface disease index (OSDI) questionnaire score. Schirmer I and tear film break-up time (TBUT) tests, as well as detailed slit-lamp examinations, were performed at baseline and at the end of the study. All participants received Xiloial monodose eye drops for the right eye and Tearlose eye drops for the left eye, administered as a single drop 4 times per day. Furthermore, they were instructed to perform lid hygiene every 12 hours per day for both eyes. Results: Thirty-five patients (70 eyes) with a mean ± standard (SD) age of 50.2 ± 13.4 years were included, and 14 (40%) were men. The mean ± SD of the OSDI score was 44.24 ± 22.59 at baseline. Of the 35 patients, 10 (28.6%), 5 (14.3%), and 20 (57.1%) had mild, moderate, and severe ocular surface disease, respectively, according to the baseline OSDI score. Compared to baseline, the mean values of both TBUT and Schirmer I tests improved significantly in both groups (both P < 0.001). In comparing the final mean values between the 2 groups, this improvement was comparable for the Schirmer I test (P = 0.179), but TBUT in Tearlose-instilled eyes improved significantly more than in the fellow eyes (P < 0.001). Conclusions: Both Xiloial and Tearlose eye drops improved tear stability and tear production after a 2 week treatment period in eyes with dry eye disease. This improvement was comparable for tear production, but Tearlose-instilled eyes showed significantly greater improvement in tear stability. Further studies with longer follow-up and larger sample sizes could provide more reliable results as a basis for the clinical use of this TSP-containing lubricant eye drop solution in dry eye disease.


2020 ◽  
Vol 30 (6) ◽  
pp. 1301-1307 ◽  
Author(s):  
María García Zamora ◽  
Eugenia Francés Caballero ◽  
Miguel J Maldonado

Purpose: The aim of this study is to evaluate the incidence, natural course, and distribution pattern of superficial punctate keratopathy and describe the changes in signs and symptoms of dry eye after cataract surgery. Setting: The setting of this study is University Hospital Rio Hortega and Instituto Universitario de Oftalmobiología Aplicada, Valladolid, Spain. Design: This is a prospective interventional study. Materials and Methods: In total, 55 eyes of 55 different patients with no history of dry eye underwent standard phacoemulsification through a 2.75-mm-wide corneal incision. We measured tear break-up time, Schirmer test I, and tear meniscus height, and recorded the Ocular Surface Disease Index score, fluorescein staining patterns, and photo documentation of the ocular surface before and 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups (with and without superficial punctate keratopathy development, 1 day postoperatively). Results: Patients (mean age: 75.75 ± 7.27 years) showed an incidence of 76.3% of superficial punctate keratopathy at 24 h. Location predominated in the center of the cornea until a week (32.7%) and then began to prevail in the inferior quadrant (21.8%) at 1 month. All dry eye tests were significantly worse after surgery. Ocular Surface Disease Index increased from 10.98 ± 5.05 to 15.87 ± 6.57 at 24 h ( p < .001), to 12.80 ± 5.77 at 7 days ( p < .001), and to 11.09 ± 4.63 at 1 month ( p = .90). Fluorescein staining patterns got worse 24 h postoperatively with a score of 2.12 using the National Eye Institute/Industry–recommended guidelines staining grid. Average break-up time values were significantly lower at 1 day (6.61 ± 2.68),1 week (6.98 ± 2.79), and 1 month (7.05 ± 2.86) postoperatively than preoperatively (8.78 ± 2.97) ( p < .001). The mean postoperative first month Schirmer test I value (8.32 ± 3.58) was significantly lower than preoperative value (9.05 ± 3.63) ( p < .001). Conclusion: Phacoemulsification tends to induce short-term transitory ocular surface impairment manifesting as both signs and symptoms. Superficial punctate keratopathy distribution has a characteristic pattern evolution according to the postoperative time. Those patients with altered preoperative values are more likely to develop ocular surface disease and for longer time.


2012 ◽  
Vol 40 (7) ◽  
pp. 675-681 ◽  
Author(s):  
Sudipta Ghosh ◽  
Fleur O'Hare ◽  
Ecosse Lamoureux ◽  
Rasik B Vajpayee ◽  
Jonathan G Crowston

2019 ◽  
Vol 30 (3) ◽  
pp. 439-445
Author(s):  
Elisa Imelde Postorino ◽  
Pasquale Aragona ◽  
Laura Rania ◽  
Rosaria Spinella ◽  
Domenico Puzzolo ◽  
...  

Purpose: To study the effects of xanthan gum eye drops on the ocular surface and conjunctival cytology of patients with mild-moderate dry eye. Methods: This prospective, double-masked, controlled trial included 30 patients (age > 60 and Ocular Surface Disease Index score >12 and <33), divided into two groups of 15 subjects and treated with 0.2% xanthan gum eye drops (group 1) or 0.5% carboxymethylcellulose (group 2) qid. After a run-in period with saline qid, patients were evaluated by Ocular Surface Disease Index questionnaire, clinical assessment, and impression cytology at baseline (T0) and after 1 month (T1). For impression cytology, cellularity, cell-to-cell contacts, nucleus/cytoplasm ratio, chromatin aspect, goblet cells distribution, keratinization, and the presence of inflammatory cells were considered. Parameters were scored from 0 (no alterations) to 3 (evident alterations). For statistical analysis, Student’s t-test, Wilcoxon rank-sum test, and Mann–Whitney U-test were used. Results: Clinically, after 1 month of treatment, group 1 showed an improvement of corneal stain (T0 = 1.1 ± 1.4; T1 = 0.5 ± 0.7; p = 0.03) and a reduction of Schirmer I test (T0 = 9.8 ± 6.1; T1 = 5.9 ± 4.1; p = 0.001). In group 2, no differences were found between T0 and T1 for all the clinical tests. For impression cytology, in group 1 cellularity (T0 = 0.6 ± 0.5; T1 = 0.3 ± 0.5; p = 0.05), chromatin aspect (T0 = 1.2 ± 0.4; T1 = 0.8 ± 0.5; p = 0.01), keratinization (T0 = 1 ± 0.7; T1 = 0.5 ± 0.5; p = 0.03), and total score (T0 = 5.8 ± 1.3; T1 = 3.6 ± 1.7; p = 0.003) were significantly ameliorated, while in group 2 only total score improved significantly (T0 = 5 ± 1.4; T1 = 4.3 ± 1.5; p = 0.01). The comparison between groups showed significant amelioration for keratinization in group 1 at T1 (p = 0.02). Conclusion: The treatment with xanthan gum, a molecule with anti-oxidant and mucoadhesive properties, ameliorated conjunctival epithelium of mild-moderate dry eye patients better than carboxymethylcellulose.


2016 ◽  
Vol 144 (7-8) ◽  
pp. 376-383
Author(s):  
Marija Radenkovic ◽  
Gordana Stankovic-Babic ◽  
Predrag Jovanovic ◽  
Jasmina Djordjevic-Jocic ◽  
Marija Trenkic-Bozinovic

Introduction. Ocular surface disease (OSD) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sj?gren and non-Sj?gren) and evaporative (extrinsic and intrinsic) form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride - BAK), which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration. Objective. The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy. Methods. Retrospective analysis of examined patients with open-angle glaucoma was used. Results. Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma). Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed. Conclusion. OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.


2019 ◽  
Vol 104 (6) ◽  
pp. 776-779 ◽  
Author(s):  
Yoav Nahum ◽  
Michael Mimouni ◽  
Eitan Livny ◽  
Irit Bahar ◽  
Emmilia Hodak ◽  
...  

AimTo identify risk factors for the development of dupilumab-induced ocular surface disease (DIOSD) in adult patients with atopic dermatitis (AD) and describe outcomes of treatment.MethodsA retrospective institutional cohort study performed at the Rabin Medical Center, Petach Tikva, Israel. Adult patients with AD who received dupilumab from March 2018 to June 2019 were included. Demographics, AD severity scores, blood IgE levels, previous atopic keratoconjunctivitis (AKC), dermatological response to dupilumab, ophthalmological evaluation and treatment were noted. Univariate and multivariate analyses were used to identify risk factors for DIOSD.ResultsSixteen of 37 patients who were included in the study (43%) had new or exacerbated symptoms of ocular surface disease starting at 2 weeks following the first treatment. Three patients reported transient dry eye sensation which lasted 2 weeks; nine patients reported chronic dry eye sensation, and four patients (25%) had marked blepharoconjunctivitis. The presence of severe AD was the strongest predictor of DIOSD. Not a single patient with moderate AD had DIOSD. In multivariate analysis, prior AKC was a risk factor for DIOSD (R2=15.78, OR=23.28, p=0.005) while a family history of atopy was protective of DIOSD (R2=6.22, OR=0.13, p=0.05). All four patients with blepharoconjunctivitis had resolution of signs, and symptoms within days of starting periocular 0.03%–0.1% tacrolimus ointment.ConclusionsDIOSD is common in patients with AD receiving dupilumab. While most cases are mild, some patients can develop blepharoconjunctivitis which responds well to tacrolimus ointment. AD severity, and previous AKC are risk factors for DIOSD.


2021 ◽  
Vol 13 ◽  
pp. 251584142110127
Author(s):  
Preeya K. Gupta ◽  
Nandini Venkateswaran

The tear film, which includes mucins that adhere to foreign particles, rapidly clears allergens and pathogens from the ocular surface, protecting the underlying tissues. However, the tear film’s ability to efficiently remove foreign particles during blinking can also pose challenges for topical drug delivery, as traditional eye drops (solutions and suspensions) are cleared from the ocular surface before the drug can penetrate into the conjunctival and corneal epithelium. In the past 15 years, there has been an increase in the development of nanoparticles with specialized coatings that have reduced affinity to mucins and are small enough in size to pass through the mucus barrier. These mucus-penetrating particles (MPPs) have been shown to efficiently penetrate the mucus barrier and reach the ocular surface tissues. Dry eye disease (DED) is a common inflammatory ocular surface disorder that often presents with periodic flares (exacerbations). However, currently approved immunomodulatory treatments for DED are intended for long-term use. Thus, there is a need for effective short-term treatments that can address intermittent flares of DED. Loteprednol etabonate, an ocular corticosteroid, was engineered to break down rapidly after administration to the ocular surface tissues and thereby reduce risks associated with other topical steroids. KPI-121 is an ophthalmic suspension that uses the MPP technology to deliver loteprednol etabonate more efficiently to the ocular tissues, achieving in animal models a 3.6-fold greater penetration of loteprednol etabonate to the cornea than traditional loteprednol etabonate ophthalmic suspensions. In clinical trials, short-term treatment with KPI-121 0.25% significantly reduced signs and symptoms of DED compared with its vehicle (placebo). Recently approved KPI-121 0.25%, with its novel drug delivery design and ease of use, has the potential to effectively treat periodic flares of DED experienced by many patients.


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