This study talks about glaucoma management yielding better results when the ocular surface is well managed. I am so used to thinking of this the other way around (i.e. glaucoma being treated without reference to dry eye, resulting in damage to the ocular surface) that I kind of gave it a double take as it's suggesting IOP can be decreased by better managing the cornea part of the equation. Still scratching my head a little. The only "duh" in it for me is that patients will be more compliant with their glaucoma medication if their corneas aren't hurting (esp. from the glaucoma medication). I'd like to understand more about other connections between OSD and glaucoma.
But in any case, anything that gets the glaucoma doc talking to the cornea doc is a big plus in my book. Treating the whole eye, rather than compartmentalizing the front and the back... what a concept! Good going.
Ocular Surface Disease Exacerbated Glaucoma: Optimizing theOcular Surface Improves Intraocular Pressure Control.
To describe a series of 4 patients with inadequately controlled primary open angle glaucoma and ocular surface disease (OSD) in whom a combination approach was used to manage the OSD resulting in improved intraocular pressure (IOP) control.
PATIENTS AND METHODS:
A retrospective review of the clinical notes of 4 patients referred to a tertiary surgical glaucoma service was performed. At the initial visit, measures to control the OSD were employed in all patients; twice-daily lid hygiene measures, a 3-month course of 50 mg daily oral doxycycline, topical carmellose sodium (celluvisc) 0.5% 4 to 6 times daily, and preservative-free equivalents of topical antiglaucoma medications as deemed appropriate, depending on the perceived severity of the OSD.
Patients were reviewed for a maximum of 24 months after intervention. In all patients treatment resulted in a marked symptomatic and clinical improvement in the ocular surface with a reduction in hyperemia, meibomian gland dysfunction and superficial keratopathy. A reduction in the IOP also occurred in all patients, obviating the need for glaucoma drainage surgery during the study period.
Patients with severe OSD often have glaucoma that is refractive to medical therapy. Furthermore, the surgical success of glaucoma filtering surgery is compromised in patients with scarring and inflammation of the conjunctiva. The term we postulate is "OSD exacerbated glaucoma." This is the first study to suggest that the use of a combination approach comprising medical treatment to manage the OSD in patients with primary open angle glaucoma may lead to an improvement in the IOP control and the management of glaucoma.
J Glaucoma. 2012 Jul 23. [Epub ahead of print]
University Hospitals Birmingham, Birmingham, UK.