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Evaluation of Ocular Surface Disease in Patients with Glaucoma: Clinical Parameters, Self-report Assessment and Keratograph Analysis

Portela, Renata C., MD; Fares, Nikoly T., MD; Machado, Lilian F., MD; São Leão, Amanda F., Medical Student; de Freitas, Denise, MD, PhD; Paranhos, Augusto Jr, MD, PhD; Prata, Tiago S., MD, PhD; Gracitelli, Carolina P.B., MD, PhD

doi: 10.1097/IJG.0000000000001007
Original Study: PDF Only

Purpose: To assess ocular surface disease (OSD) in glaucoma using clinical parameters, self-report assessment and keratograph analysis.

Methods: A total of 30 glaucoma patients and 27 subjects with cataracts (control group) were enrolled in the study. Only glaucoma patients who were using at least 1 topical intraocular pressure (IOP)-lowering medication were included. An ophthalmological examination was performed, including tear break-up time, assessment of conjunctival hyperemia and keratitis, and completion of the Ocular Surface Disease Index (OSDI) questionnaire. All the patients underwent keratograph analysis including noninvasive BUT, meibography, tear meniscus height, and redness scale. Quality of life was also assessed in all the patients using NEI VFQ-25. The comparison of OSD between the two groups was assessed.

Results: There was a significant difference in OSD: keratitis and conjunctival hyperemia were worse in the glaucoma group (P=0.009 and P=0.008, respectively). The glaucoma group had significantly worse scores on the OSDI questionnaire (32.53±20.75 vs. 20.42±18.77; P=0.007). For the keratograph assessment, the glaucoma group had significantly smaller tear meniscus height (0.22±0.08 vs. 0.24±0.04, respectively; P=0.041); worse bulbar redness (2.06±0.67 vs. 1.70±0.45, respectively; P=0.021); higher meibography grades (2.34±1.01 vs. 1.52±0.64, respectively; P=0.001); and worse non-invasive keratograph tear BUT (5.45±4.16 vs. 8.40±5.65, respectively; P=0.023). Patients with glaucoma had a worse quality of life (60.73±18.25 vs. 76.62±8.03, respectively; P=0.039).

Conclusions: Our findings not only confirm the high prevalence of clinical findings of OSD in glaucoma patients but also reveal new objective parameters measured by keratograph analysis.

Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of São Paulo, São Paulo, Brazil

Funding: None.

Disclosures: The authors declare no conflict of interest regarding the present study.

Reprints: Carolina P. B. Gracitelli, MD, PhD Rua Botucatu, 821. Vila Clementino. São Paulo – São Paulo, Brasil, CEP: 04023-062 (e-mail:

Received March 16, 2018

Accepted June 8, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.