Rethinking Dry Eye and Ocular Surface Disesase in Glaucoma: Pathophysiology, Diagnosis, and Management
Miriam KolkoPurpose:
To highlight the overlooked role of ocular surface disease (OSD) in glaucoma, explore its pathophysiological links to treatment, and propose integrated strategies to improve patient care.
Methods:
A narrative review of current literature on the relationship between glaucoma therapies and ocular surface health was conducted. Evidence on prevalence, mechanisms, diagnostic approaches, and management strategies for OSD in glaucoma patients was reviewed.
Results:
Glaucoma remains the leading cause of irreversible blindness worldwide, with treatment adherence being a critical determinant of long-term outcomes. Chronic use of topical intraocular pressure (IOP)-lowering eye drops, particularly those containing benzalkonium chloride (BAK), induces epithelial and goblet cell toxicity, tear film instability, and ocular inflammation. The prevalence of OSD in glaucoma patients is markedly higher than in the general population, affecting up to 60%. Symptoms such as dryness, burning, and blurred vision significantly reduce quality of life and compromise adherence to treatment. Emerging alternatives, including preservative-free formulations, selective laser trabeculoplasty, and minimally invasive glaucoma surgery, provide opportunities to reduce ocular surface burden. Structured evaluation using questionnaires, slit-lamp examination, and diagnostic tests can facilitate early detection and tailored management.
Conclusions:
The ocular surface, long considered secondary in glaucoma care, is central to optimizing both adherence and visual outcomes. Protecting ocular surface health through preservative-sparing regimens, procedural interventions, and patient-centered strategies is essential. Reframing OSD as an integral component of glaucoma management may improve long-term quality of life and enhance treatment success.