What To Do When Glaucoma Medications Cause Dry EyesPeople on topical glaucoma medications can development dry eye disease. For severe cases, multiple glaucoma medications are used. With increasing research showing a relationship between meibomian gland dysfunction (MGD) and glaucoma therapy, therefore, it is necessary that people with glaucoma patients get evaluation for dry eye disease at every exam. This evaluation should include meibomian gland evaluation with both expression (squeeze) and gland imaging using , LipiView, Meibography or transillumination.2,3
What To Do For Dry Eyes
If dry eye is diagnosed according to TFOS DEWS II criteria, Reduced tear volume using TBUT (Tear Breakup Time), hyperosmolarity ( too salty) , or corneal and conjunctival staining with vital dye testing. If results indicate severe dry eyes, alternative approaches should be considered. Use of a prostaglandin analogue (PGA) could present with symptoms of dry eye and decreased TBUT due to the known obstruction of the meibomian glands often associated with these medications.3 Changing the class of medication for this patient could very well improve gland function, tear stability, and symptoms.
In the case where a topical beta blocker is used and presented with corneal staining and symptoms of dry eye. The person could have decreased aqueous production as a result of the beta blocker and/or corneal epithelial breakdown from exposure to the BAK preservative. For this type of people, consider changing to a preservative-free formulation, or to a non-preserved PGA such as Zioptan (with close evaluation of the meibomian glands), or even to a PGA with an alternate preservative such as Travatan Z, in order to continue with the ease of a once-daily dosing schedule.
For the dry eye patient who is taking multiple glaucoma medications, consider recommending surgical treatments such as SLT or MIGS in attempts to reduce the overall medication and preservative load. When surgery isn't an option or medications cannot be changed, elect to treat the dry eye disease in conjunction with their glaucoma management. Consider thermal pulsation therapy (IPL) for obstructive MGD combined with topical therapies such as TheraLife Eye capsules to control inflammation. Helping to maintain quality of life for people is important. Specifically, for our glaucoma patients, the medications used to treat their disease can often worsen their quality of life and contribute to poor medication adherence. It is therefore imperative to monitor for dry eye disease for all glaucoma patients at every visit.
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1. TFOS DEWS II iatrogenic report. Ocul Surf. 2017 Jul;15(3):511-538. doi: 10.1016/j.jtos.2017.05.004. Epub 2017 Jul 20.
2. Uzunosmanoglu E1, Mocan MC, Kocabeyoglu S, Karakaya J, Irkec MMeibomian Gland Dysfunction in Patients Receiving Long-Term Glaucoma Medications. Cornea. 2016 Aug;35(8):1112-6.
3. Mocan MC1, Uzunosmanoglu E, Kocabeyoglu S, Karakaya J, Irkec M.The Association of Chronic Topical Prostaglandin Analog Use With Meibomian Gland Dysfunction. J Glaucoma. 2016 Sep;25(9):770-774.