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BioMed Research International
Volume 2013 (2013), Article ID 696328, 7 pages
Review Article

How Ocular Surface Disease Impacts the Glaucoma Treatment Outcome

1Department of Ophthalmology, Clinical Hospital Dubrava, Avenue Gojka Šuška 6, 10 000 Zagreb, Croatia
2Department of Ophthalmology, University Clinic Vuk Vrhovac, Clinical Hospital Merkur, Zajčeva Ulica 19, 10 000 Zagreb, Croatia
3Department of Ophthalmology, Clinical Hospital “Sveti Duh,” Sveti Duh 64, 10 000 Zagreb, Croatia

Received 30 April 2013; Accepted 5 September 2013

Academic Editor: Gennady Landa

Copyright © 2013 Snježana Kaštelan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The treatment goals for glaucoma are lowering the intraocular pressure and preservation of vision. Topical hypotensive drops are the standard form of therapy which is often associated with some symptoms of toxicity, ocular inflammation, allergy, or ocular surface disease (OSD). OSD is a common comorbidity in glaucoma patients, and its prevalence with glaucoma increases with age. Use of topical treatment could additionally increase symptoms of OSD mostly due to preservatives added to multidose medication bottles used to reduce the risk of microbial contamination. This toxicity has been particularly associated with BAK, the most commonly used preservative which damages conjunctival and corneal epithelial cells and significantly aggravates OSD symptoms. OSD adversely affects patients’ quality of life causing discomfort and problems with vision which in turn may result in noncompliance, lack of adherence, and eventually visual impairment. In the management of glaucoma patients OSD symptoms should not be overlooked. If they are present, topical glaucoma treatment should be adapted by decreasing the amount of drops instilled daily, using BAK-free or preservative-free medication and lubricants if necessary. Awareness of the presence and importance of OSD will in turn improve patients' adherence and compliance and thus ultimately the preservation of long-term vision.