When a patient has glaucoma, we have to give drops to regulate and often lower eye pressures in order to save the eye(s)’ vision. These drops though, we have known for years, makes dry eye symptoms worse. More and more studies are showing how glaucoma drops can potentially destroy meibomian glands.
If anyone develops a glaucoma drop that maybe has extra Omega 3 or is shown to save glands, that will be better for patients.
Sandra Lora Cremers, MD, FACS
2017 Dec 8. doi: 10.1097/ICO.0000000000001489. [Epub ahead of print]
Eyelid Changes Related to Meibomian Gland Dysfunction in Early Middle-Aged Patients Using Topical Glaucoma Medications.
To investigate the relationship between topical glaucoma medications and meibomian gland dysfunction (MGD) in early middle-aged patients with glaucoma.
In this cross-sectional study, 50 patients with glaucoma younger than 50 years who had used topical glaucoma medications for more than 6 months and 40 normal controls of similar age were included. Patients in each group were graded for MGD (0-4) using slit-lamp microscopy. Tear film breakup time (BUT), ocular surface staining, and Marx line scores were also evaluated. Differences between both groups were analyzed statistically.
The prevalence of MGD was 82% in the group using topical glaucoma medications and 52.5% in the control group. The average period of topical glaucoma medication use was 27.4 months. There were significant differences in the breakup time and Marx line score according to the presence of MGD. Although the duration of topical glaucoma medication use and the severity of MGD did not show a significant correlation, the degree of MGD and the Marx line score were significantly correlated.
Glaucoma eye drops may be one factor affecting the eyelid changes associated with MGD. The Marx line score may be used as an index to evaluate MGD in patients with glaucoma.
Effects of long-term topical anti-glaucoma medications on meibomian glands
To examine effects of long-term topical anti-glaucoma medications on meibomian gland morphology and function and assess their relationship with slit-lamp findings.
This was a cross-sectional observational case series of 31 patients with glaucoma (mean age ± standard deviation, 65.0 ± 13.0 years; mean duration of eye drop use, 7.9 ± 6.0 years) treated with topical anti-glaucoma drugs in only one eye for more than 1 year: 13 receiving prostaglandin analogues (PGs) alone, eight receiving β-blockers alone, and ten receiving multiple treatments. Untreated contralateral eyes served as controls. Lid margin (lid margin abnormality score: 0–4) and superficial punctate keratopathy (SPK score: 0–1) were observed with a slit lamp. Upper and lower eyelids were turned over to observe meibomian glands using non-contact meibography. Meibomian gland loss was scored for each eyelid from grade 0 (no loss of meibomian glands) through grade 3 (loss >2/3 of total meibomian gland area). Meibomian lipid content (meibum) was scored (meibum score: 0–3).
Treated eyes had significantly higher scores for lid margin abnormality (P = 0.001), SPK (P < 0.001), meibo-score (P < 0.001), and meibum (P < 0.001) than control eyes. Tear film break-up time (BUT) was significantly shorter in treated eyes than in control eyes (P = 0.001). Schirmer values were significantly lower in treated eyes than in control eyes (P = 0.0039). Subgroup analysis indicated a significantly higher meibo-score in eyes treated with PGs (P = 0.0046) and in eyes treated with β-blockers (P = 0.0231) than in the corresponding controls.
Long-term anti-glaucoma eye drop use affects meibomian gland morphology and function.