Antiglaucomatous treatments and ocular surface.

Background: the antiglaucomatous treatments interact with the ocular surface and can induce its alteration which may affect the therapeutic results Aim : to describe the interactions between the ocular surface and anti-glaucoma medications and to propose practical attitudes to prevent and manage this issue.

Methods: a retrospective study about 100 patients with a primary opened angle glaucoma treated with anti-glaucomatous drops containing preservatives. We performed an exhaustive examination of the ocular surface with fluorescein instillation to search superficial punctuate keratitis and to evaluate the break up time. All patients had a Schirmer test I.

Results: our patients were under monotherapy in 46% ,two medications in 36%, three medications in 11% and four medications in 7% .Beta-blockers were statistically related to the conjunctival hyperaemia (p = 0.014), BUT alteration (p = 0.001) and Schirmer test ≤ 5 mm (p = 0.0001). Prostaglandin analogues were statistically related to a Schirmer test ≤ 5 mm (p = 0.02). The use of more than two anti-glaucomatous medications was linked to the severity of the clinical signs.

Conclusions: anti glaucoma drops affect the ocular surface through several mechanisms: allergic reaction, direct and indirect toxicity of the active agents as well as their preservatives. The risk is increased by the prior ocular surface abnormalities in these patients. This disease influences the quality of life and leads to poor adherence to treatment.