Effects of Common Topical Antiglaucoma Medications on the Ocular Surface, Eyelids and Periorbital Tissue

Abstract

Glaucoma affects millions of people around the world. With the baby boom generation aging, the number of people affected by primary open-angle glaucoma in the US is expected to reach 3.3 million by 2020, and about half may not know they have the disease. The treatment of most forms of glaucoma includes the use of topical agents that enhance aqueous humour outflow, reduce aqueous production, or both. Topical intraocular pressure-lowering drugs must penetrate across the tissues of the eye to reach their therapeutic targets. Often, these tissues show the first signs and symptoms of drug toxicity and adverse effects. These include eyelid dermatitis, malpositions, lacrimal system scarring, ocular discomfort upon instillation, tear film instability, conjunctival inflammation, subconjunctival fibrosis, conjunctival epithelium changes, and corneal surface and endothelial impairment. For these reasons, ophthalmologists should evaluate the risks and benefits of ophthalmic medications before initiating therapy, identify the minimum dosages necessary to achieve a therapeutic benefit, and monitor patients for local and systemic adverse effects. Adverse events may be reduced by changing to a different class of topical medication, using corticosteroids, lubricating the eyes frequently, and reducing exposure to preservatives. This in turn can lead to higher levels of adherence to antiglaucoma therapy, improved outcomes and a reduction in the costs associated with long-term glaucoma complications. This article reviews the ocular adverse effects associated with the various classes of topical antiglaucoma drugs, with a particular focus on the ocular surface, eyelids and periorbital tissue.

Ocular Surface Disease in Patients under Topical Treatment for Glaucoma

“…The main explanatory factors for the OSDI scores obtained in our study participants were age, treatment duration, and corneal epitheliopathy (abnormal fluorescein corneal staining). Older subjects, whether under therapy or not with IOP-lowering drugs, commonly show symptoms of OSD (7,12,37). A longer treatment duration has been found to increase OSD symptoms (22,23).…”

The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on

“…In the latter group severe inflammation and scarring may be associated with most non preserved glaucoma medications, as well as due to preservatives: 16 the inflammation will often rapidly resolve on withdrawal of the drops although this may take 2-6 weeks to improve and longer to resolve. 17 Oral acetazolamide will often be tolerated by this group of patients, at least for 1-2 weeks to confirm the diagnosis of toxicity/allergy to topical medications.…”

Level of agreement among Latin American glaucoma subspecialists on the diagnosis and treatment of glaucoma: results of an online survey

“…Prostaglandin analogs have demonstrated greater hypotensive efficacy compared with other classes of topical glaucoma therapies (22,23) and a low rate of systemic adverse effects, a fact with which the Latin American respondents to our survey also showed substantive agreement. The most common adverse event with prostaglandin analogs is conjunctival hyperemia, whereas this is less frequent with topical β-blockers (24) . Latin American physicians agree that topical β-blockers have the best ocular safety profile (question 31).…”