Dry eye disease or dysfunctional tear syndrome is among the most frequent diagnoses in ophthalmology. It is a multifactorial disease of the ocular surface and tear film which results in ocular discomfort, visual disturbances, and tear instability with potential damage to the cornea and conjunctiva. Risk factors for dry eye syndrome include age, sex (female gender), race, contact lens wear, environment with low humidity, systemic medications, and autoimmune disorders. The aim of this paper is to present the systematic classification, epidemiology, diagnostic procedures, and advances in the management of dry eye disease. The recent improvements in comprehending the underlying etiologic factors will inevitably improve future classifications and diagnostic abilities leading to more effective therapeutic options. Treatment of this highly prevalent condition can drastically improve the quality of life of individuals and prevent damage to the ocular surface.

The treatment goals for glaucoma are lowering the intraocular pressure and preservation of vision. Topical hypotensive drops are the standard form of therapy which is often associated with some symptoms of toxicity, ocular inflammation, allergy, or ocular surface disease (OSD). OSD is a common comorbidity in glaucoma patients, and its prevalence with glaucoma increases with age. Use of topical treatment could additionally increase symptoms of OSD mostly due to preservatives added to multidose medication bottles used to reduce the risk of microbial contamination. This toxicity has been particularly associated with BAK, the most commonly used preservative which damages conjunctival and corneal epithelial cells and significantly aggravates OSD symptoms. OSD adversely affects patients' quality of life causing discomfort and problems with vision which in turn may result in noncompliance, lack of adherence, and eventually visual impairment. In the management of glaucoma patients OSD symptoms should not be overlooked. If they are present, topical glaucoma treatment should be adapted by decreasing the amount of drops instilled daily, using BAK-free or preservative-free medication and lubricants if necessary. Awareness of the presence and importance of OSD will in turn improve patients' adherence and compliance and thus ultimately the preservation of long-term vision.

Purpose. Primary open-angle glaucoma (POAG), a chronic, degenerative optic neuropathy, requires persistent decrease of intraocular pressure so as to prevent visual impairment and blindness. However, long-term use of topical ocular medications may affect ocular surface health. Purpose of this study was to evaluate the influence of BAK-preserved prostaglandin analog treatment on the ocular surface health in patients with newly diagnosed POAG. Methods. 40 newly diagnosed POAG patients were included in this prospective study. Intraocular pressure (IOP), tear break-up time (TBUT), and ocular surface disease index (OSDI) were assessed at baseline and 3-month after starting treatment with BAK-preserved travoprost 0.004%. Results. IOP decreased in all patients from baseline to 3-month final visit (23.80 ± 1.73 mmHg versus 16.78 ± 1.27 mmHg; P < 0.001). Mean TBUT decreased from 11.70 ± 1.86 seconds at baseline to 8.30 ± 1.29 seconds at 3-month final visit (<0.001). Mean OSDI score increased from 31.63 ± 18.48 to 44.41 ± 16.48 (P < 0.001). Conclusions. This study showed that BAK-preserved travoprost 0.004% is an effective medication in newly diagnosed POAG patients, but its long-term use may negatively influence ocular surface health by disrupting the tear film stability. Further studies are needed to better understand the clinical effects of different preservative types and concentrations on the ocular surface.

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material is associated with abnormal metabolism of glycosaminoglycans and thus abnormalities of the basement membrane in the epithelial cells. Pseudoexfoliation syndrome occurs in all areas of the world with varying frequency. There is a high prevalence of pseudoexfoliation syndrome in Scandinavian countries, Arabic populations and in Oman [6,7] whilst it is relatively rare among African Americans, Eskimos and Canadian Arctic populations. Pseudoexfoliation syndrome is more common in females than in males [8] and its prevalence increases steadily with age and is rarely seen before the age of 50. Jonasson et al. reported a 10% annual increase for both open-angle glaucoma and pseudoexfoliation in persons of 50 years and over in Iceland 9]. The reported mean age ranges from 69-75 years. Genetic factors influencing pseudoexfoliation has been explored considerably in the latest decade [10]. Recent genetic studies in multiple populations have identified the lysyl oxidase-like 1 (LOXL1) gene as a major contributor to the risk of developing pseudoexfoliation syndrome and pseudoexfoliation glaucoma. LOXL1 belongs to the lysyl oxidase family of extracellular enzymes that have multiple functions including the synthesis and maintenance of elastic fibres. However, the exact relationship between LOXL1 polymorphisms and the development of pseudoexfoliation has not been completely elucidated and thus the value of genetic testing for this disorder for the time being has not been validated [11]. In addition to heritable a number of nongenetic factors such as ultraviolet light, autoimmunity, slow virus infection, and trauma are supposed to have an implication in the development of pseudoexfoliation. It is possible that a combination of genetic and nongenetic factors may be involved