The prevalence of glaucoma and ocular surface disease

A large number of my glaucoma patients express to me that their eyes are red, burn, feel irritated, and their vision fluctuates throughout the day. They wish there was a way to get relief without increasing the chances of their glaucoma worsening. This scenario is common in any clinic that manages patients with glaucoma. The prevalence of glaucoma and ocular surface disease increases with age, so many times these conditions occur simultaneously. Adding to the increase in prevalence as our patient’s age is that ocular surface disease has been shown to be more prevalent in glaucoma patients on topical glaucoma medications.

A May 2017 study published in the European Journal of Ophthalmology revealed significantly higher OSDI and corneal staining in a group of patients on topical glaucoma medications. The main factors impacting ocular surface disease were drops with preservatives, longer treatment duration, and older age. What is the solution for our patients with a progressive disease like glaucoma, and a debilitating disease like ocular surface disease?

Treating the ocular surface is a must, and the level of treatment will be dictated by the severity of the ocular surface disease. Treatment options may include artificial tears, cyclosporine ophthalmic emulsion 0.05%, lifitegrast ophthalmic solution 5%, topical corticosteroids, punctal occlusion, Omega-3 fatty acids, and meibomian gland expression. Another consideration is reducing the amount of topical glaucoma medications that come into contact with the ocular surface.


Minimally invasive glaucoma surgeries (MIGS) offer our patients an opportunity to reduce the burden of medications with safe and effective outcomes. A variety of MIGS studies have shown decreased use of medications and reduced intraocular pressure. A win-win for patients that are suffering from ocular surface disease and glaucoma.

Multiple drug delivery systems are currently undergoing clinical trials. These include a bimatoprost ring, travoprost punctum plug, latanoprost-eluting contact lens bimatoprost intraocular implant, travoprost extended release implant and travoprost intraocular implant. Many are showing intraocular pressure lowering results equal to one glaucoma medication.

It is easy to fixate on the disease that can cause permanent vision loss when managing glaucoma patients, but managing co-existing ocular surface disease will improve their quality of life.