Glaucoma Therapy and Ocular Surface Disease

Current Literature and Recommendations

Zane Anwar; Sarah R. Wellik; Anat Galor


Curr Opin Ophthalmol. 2013;24(2):136-143. 

In This Article

Abstract and Introduction


Purpose of review To provide an update on clinical and experimental literature for ocular surface effects of glaucoma therapy and to provide practical guidelines for ophthalmologists treating glaucoma patients with ocular surface disease (OSD).

Recent findings Preservatives, notably benzalkonium chloride (BAK), continue to contribute to OSD and demonstrate a variety of toxic ocular effects both in-vitro, and in animal/human studies. Recent literature frequently compares BAK with Polyquad, SofZia, and preservative-free therapies. Some clinical benefit has been demonstrated with newer BAK-free alternatives.

Summary BAK-free and preservative-free therapies are becoming available but are not always a feasible alternative. It is important to recognize different clinical manifestations of allergy and chronic inflammation and to discuss options for patients experiencing OSD.


Over 60 million individuals worldwide suffer from glaucoma, projected to increase to almost 80 million in 2020.[1] Up to 40% of the glaucoma population in the USA requires more than one agent to effectively lower intraocular pressure (IOP).[2] Ocular surface disease (OSD) and dry eye syndrome (DES) are present in 15% of the elderly population and have been reported in several studies to be more common in patients with glaucoma. Using the ocular surface disease index (OSDI) score, it has been shown that up to 60% of glaucoma patients have OSD, both of which can independently impact quality of life and compliance.[3,4,5] It has been postulated that multiple, daily exposures of the ocular surface to active compounds and preservatives can worsen the burden of OSD in this population.