Challenges in the Management of Glaucoma in a Patient with Severe Ocular Surface Disease: A Case Report

Ocular surface disease (OSD) is a significant problem for glaucoma patients worldwide, who will require long-term topical treatment. The risk of OSD increases with age, with a reported prevalence of up to 60%. The severity and burden of OSD also increase with the number of topical anti-glaucoma medications used in treatment due to multiple, daily exposures of the ocular surface (OS) to toxic active compounds in the drug itself, other components of the formulation or preservatives. 

The presentation of OSD varies depending on its severity, but usually includes symptoms of dry eyes, allergy and distorted vision, which can be debilitating and affect quality of life. The clinical signs of the diseaseinclude tear-film instability, toxic kerato conjunctivitis, eyelid abnormalities and allergic manifestations. However, the lack of concordance between symptoms and signs often makes the diagnosis of OSD and assessment of its severity challenging.