Skip to main content

Advertisement

Log in

Effects of long-term topical anti-glaucoma medications on meibomian glands

  • Cornea
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Objective

To examine effects of long-term topical anti-glaucoma medications on meibomian gland morphology and function and assess their relationship with slit-lamp findings.

Methods

This was a cross-sectional observational case series of 31 patients with glaucoma (mean age ± standard deviation, 65.0 ± 13.0 years; mean duration of eye drop use, 7.9 ± 6.0 years) treated with topical anti-glaucoma drugs in only one eye for more than 1 year: 13 receiving prostaglandin analogues (PGs) alone, eight receiving β-blockers alone, and ten receiving multiple treatments. Untreated contralateral eyes served as controls. Lid margin (lid margin abnormality score: 0–4) and superficial punctate keratopathy (SPK score: 0–1) were observed with a slit lamp. Upper and lower eyelids were turned over to observe meibomian glands using non-contact meibography. Meibomian gland loss was scored for each eyelid from grade 0 (no loss of meibomian glands) through grade 3 (loss >2/3 of total meibomian gland area). Meibomian lipid content (meibum) was scored (meibum score: 0–3).

Results

Treated eyes had significantly higher scores for lid margin abnormality (P = 0.001), SPK (P < 0.001), meibo-score (P < 0.001), and meibum (P < 0.001) than control eyes. Tear film break-up time (BUT) was significantly shorter in treated eyes than in control eyes (P = 0.001). Schirmer values were significantly lower in treated eyes than in control eyes (P = 0.0039). Subgroup analysis indicated a significantly higher meibo-score in eyes treated with PGs (P = 0.0046) and in eyes treated with β-blockers (P = 0.0231) than in the corresponding controls.

Conclusions

Long-term anti-glaucoma eye drop use affects meibomian gland morphology and function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Van Buskirk EM (1979) Corneal anesthesia after timolol maleate therapy. Am J Ophthalmol 88(4):739–743

    PubMed  Google Scholar 

  2. Van Buskirk EM (1980) Adverse reactions from timolol administration. Ophthalmology 87(5):447–450

    PubMed  Google Scholar 

  3. Weissman SS, Asbell PA (1990) Effects of topical timolol (0.5%) and betaxolol (0.5%) on corneal sensitivity. Br J Ophthalmol 74(7):409–412

    Article  PubMed  CAS  Google Scholar 

  4. Wilson RP, Spaeth GL, Effie P (1980) The place of timolol in the practice of ophthalmology. Ophthalmology 87:451–454

    PubMed  CAS  Google Scholar 

  5. Alm A, Stjernschantz J (1995) The Scandinavian latanoprost study group. Effects on intraocular pressure and side effects of 0.005% latanoprost applied once daily, evening or morning. Ophthalmology 102:1743–1752

    PubMed  CAS  Google Scholar 

  6. Watson P, Stjernschantz J (1996) The latanoprost study group. A six-month, randomized, double-masked study comparing latanoprost with timolol in open-angle glaucoma and ocular hypertension. Ophthalmology 103:126–137

    PubMed  CAS  Google Scholar 

  7. Camras CB (1996) The United States Latanoprost Study Group. Comparison of latanoprost and timolol in patients with ocular hypertension and glaucoma. Ophthalmology 103:138–147

    PubMed  CAS  Google Scholar 

  8. Kuppens EVMJ, Stolwijk TR, de Keizer RJW, van Best JA (1992) Basal tear turnover and topical timolol in glaucoma patients and healthy controls by fluorophotometry. Invest Ophthalmol Vis Sci 33:3442–3448

    PubMed  CAS  Google Scholar 

  9. Herreras JM, Pastor JC, Calonge M, Asensio VM (1992) Ocular surface alteration after long-term treatment with an antiglaucomatous drug. Ophthalmology 99:1082–1088

    PubMed  CAS  Google Scholar 

  10. Arici MK, Arici DS, Topalkara A, Güler C (2000) Adverse effects of topical anti-glaucoma drugs on the ocular surface. Clin Exp Ophthalmol 28:113–117

    Article  CAS  Google Scholar 

  11. Thygesen J, Aaen K, Theodorsen F, Kessing SV, Prause JU (2000) Short-term effect of latanoprost and timolol eye drops on tear fluid and the ocular hypertension. Acta Ophthalmol Scand 78:37–41

    Article  PubMed  CAS  Google Scholar 

  12. Sherwood MB, Grierson I, Millar L, Hitchings RA (1989) Long-term morphologic effects of antiglaucomatous drugs on the conjunctiva and Tenon’s capsule in glaucoma patients. Ophthalmology 96:327–335

    PubMed  CAS  Google Scholar 

  13. Baudouin C, Garcher C, Haouat N, Bron A, Gastaud P (1994) Expression of inflammatory membrane markers by conjunctival cells in chronically treated patients with glaucoma. Ophthalmology 101(3):454–460

    PubMed  CAS  Google Scholar 

  14. Baudouin C, Liang H, Hamard P, Riancho L, Creuzot-Garcher C, Warnet JM, Brignole-Baudouin F (2008) The ocular surface of glaucoma patients treated over the long term expresses inflammatory markers related to both T-helper 1 and T-helper 2 pathways. Ophthalmology 115(1):109–115

    Article  PubMed  Google Scholar 

  15. Sharif NA, Kelly CR, Crider JY, Williams GW, Xu SX (2003) Ocular hypotensive FP prostaglandin (PG) analogs: PG receptor subtype binding affinities and selectivities, and agonist potencies at FP and other PG receptors in cultured cells. J Ocul Pharmacol Ther 19(6):501–515

    Article  PubMed  CAS  Google Scholar 

  16. Ota T, Murata H, Sugimoto E, Aihara M, Araie M (2005) Prostaglandin analogues and mouse intraocular pressure: effects of tafluprost, latanoprost, travoprost, and unoprostone, considering 24-hour variation. Invest Ophthalmol Vis Sci 46(6):2006–2011

    Article  PubMed  Google Scholar 

  17. Burstein NL (1985) The effects of topical drugs and preservatives on the tears and corneal epithelium in dry eye. Trans Ophthalmol Soc UK 104:402–409

    PubMed  Google Scholar 

  18. Baudouin C, de Lunardo C (1998) Short-term comparative study of topical 2% carteolol with and without benzalkonium chloride in healthy volunteers. Br J Ophthalmol 82(1):39–42

    Article  PubMed  CAS  Google Scholar 

  19. Norm MS, Opauszki A (1977) Effects of ophthalmic vehicles on the stability of the precorneal tear film. Acta Ophthalmol 55:23–32

    Google Scholar 

  20. Yalvaç IS, Gedikoğlu G, Karagöz Y, Akgün U, Nurözler A, Koç F, Kasim R, Duman S (1995) Effects of antiglaucoma drugs on ocular surface. Acta Ophthalmol Scand 73(3):246–248

    Article  PubMed  Google Scholar 

  21. Kuppens EV, van Best JA, Sterk CC, de Keizer RJ (1995) Decreased basal tear turnover in patients with untreated primary open-angle glaucoma. Am J Ophthalmol 120(1):41–46

    PubMed  CAS  Google Scholar 

  22. Kuppens EV, de Jong CA, Stolwijk TR, de Keizer RJ, van Best JA (1995) Effect of timolol with and without preservative on the basal tear turnover in glaucoma. Br J Ophthalmol 79(4):339–342

    Article  PubMed  CAS  Google Scholar 

  23. Wilson WS, Duncan AJ, Jay JL (1975) Effect of benzalkonium chloride on the stability of the precorneal tear film in rabbit and man. Br J Ophthalmol 59:667–669

    Article  PubMed  CAS  Google Scholar 

  24. Arita R, Itoh K, Inoue K, Amano S (2008) Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology 115:911–915

    Article  PubMed  Google Scholar 

  25. Shimazaki J, Goto E, Ono M, Shimmura S, Tsubota K (1998) Meibomian gland dysfunction in patients with Sjogren syndrome. Ophthalmol 105:1485–1488

    Article  CAS  Google Scholar 

  26. Leung EW, Medeiros FA, Weinreb RN (2008) Prevalence of ocular surface disease in glaucoma patients. J Glaucoma 17(5):350–355

    Article  PubMed  Google Scholar 

  27. Inoue K, Okugawa K, Kato S, Inoue Y, Tomita G, Oshika T, Amano S (2003) Ocular factors relevant to anti-glaucomatous eyedrop-related keratoepitheliopathy. J Glaucoma 12(6):480–485

    Article  PubMed  Google Scholar 

  28. Brandt JD, Wittpenn JR, Katz LJ, Steinmann WN, Spaeth GL (1991) Conjunctival impression cytology in patients with glaucoma using long-term topical medication. Am J Ophthalmol 112(3):297–301

    PubMed  CAS  Google Scholar 

  29. Broadway DC, Grierson I, O’Brien C, Hitchings RA (1994) Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch Ophthalmol 112(11):1437–1445

    Article  PubMed  CAS  Google Scholar 

  30. Baudouin C, de Lunardo C (1998) Short term comparative study of topical 2% carteolol with and without benzalkonium chloride in healthy volunteers. Br J Ophthalmol 82:39–42

    Article  PubMed  CAS  Google Scholar 

  31. Jester JV, Nicolaides N, Smith R (1981) Meibomian gland studies: histologic and ultrastructural investigations. Invest Ophthalmol Vis Sci 20:537–547

    PubMed  CAS  Google Scholar 

  32. Nicolaides N, Santos EC, Smith RE, Jester JV (1989) Meibomian gland dysfunction, III: meibomian gland lipids. Invest Ophthalmol Vis Sci 30:946–951

    PubMed  CAS  Google Scholar 

  33. Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Tomidokoro A, Amano S (2010) Meibomian gland duct distortion in patients with perennial allergic conjunctivitis. Cornea 29:858–860

    Article  PubMed  Google Scholar 

  34. Burstein NL (1980) Preservative cytotoxic threshold for benzalkonium chloride and chlorhexidine digluconate in cat and rabbit corneas. Invest Ophthalmol Vis Sci 19(3):308–313

    PubMed  CAS  Google Scholar 

  35. Pauly A, Meloni M, Baudouin FB, Warnet JM, Baudouin C (2009) Multiple endpoint analysis of the 3D-reconstituted corneal epithelium after treatment with benzalkonium chloride: early detection of toxic damage. Invest Ophthalmol Vis Sci 50(4):1644–1652

    Article  PubMed  Google Scholar 

  36. Ishibashi T, Yokoi N, Kinoshita S (2003) Comparison of the short-term effects on the human corneal surface of topical timolol maleate with and without benzalkonium chloride. J Glaucoma 12(6):486–490

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Reiko Arita.

Additional information

The authors have no commercial or proprietary interest in the products or companies mentioned in the current article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arita, R., Itoh, K., Maeda, S. et al. Effects of long-term topical anti-glaucoma medications on meibomian glands. Graefes Arch Clin Exp Ophthalmol 250, 1181–1185 (2012). https://doi.org/10.1007/s00417-012-1943-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-1943-6

Keywords

Navigation