Detecting ocular surface disease
In a busy glaucoma clinic, it is not necessary to measure tear film break-up time, tear secretion and tear osmolarity. In contrast, asking the patients about sudden tearing, red eyes and feelings of eye discomfort takes only a few seconds; and paying attention to the conjunctiva (folds, grainy tear film, redness, filaments), lid margin (Meibomian gland status) and ocular surface staining after fluorescein instillation but before measuring intraocular pressure, is similarly fast.
When OSD is detected, it is recommended to introduce PF artificial tear substitution, and to start topical cyclosporine medication, which has been increasingly available in the past years. Topical cyclosporine therapy targets inflammation, an important and obligatory part of OSD.
However, these efforts, which may be enough for patients who only have OSD, are not sufficient for patients with OSD and topically treated glaucoma. In the latter, common situation, the topical glaucoma medication also needs to be changed for PF medication, in order to eliminate the detrimental effects of BAK on the ocular surface.
Since PF glaucoma medication choices are widely available for almost all drug classes, no technical obstacles against this treatment change exist in most countries. However, ophthalmologists need to understand that OSD does cause suffering to the patients, and need to pay attention to the patients’ complaints and OSD signs.
This is not difficult and nor is it time consuming. It only requires the ophthalmologist to have the intention to pay attention to detecting OSD.
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