F. Pérez Bartolomé, Pedro Arriola Villalobos, Pouya Alaghband, José Manuel Benítez del Castillo Sánchez
This review presents an exhaustive analysis of the current literature on ocular surface disease (OSD) in glaucoma. OSD in this population mainly manifests in the cornea and conjunctiva as superfi cial punctate keratitis and tear fi lm instability, aggravated by the chronic use of intraocular pressure–lowering medications; this could account for poor treatment adherence and worsening of the patient’s quality of life. A large body of literature has found increasing evidence implicating preservatives as the main factor, through both in vitro and clinical studies, especially in regard to benzalkonium chloride. However, the impact of preservatives on clinical practice varies in diff erent studies. Th e decision to use preservative-free medication or alternative preservatives should therefore be assessed on an individual basis, whereby some subpopulations with abnormal tearing, decreased tear break-up time (TBUT) or corneal staining could benefi t. Clinical assessment with validated quality of life questionnaires, corneal and conjunctival staining, TBUT and Schirmer’s test is mandatory in these populations.
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