title: Ocular surface disease exacerbated glaucoma: optimizing the ocular surface improves intraocular pressure control.
abstract: OBJECTIVE
  To describe a series of 4 patients with inadequately controlled primary open angle glaucoma and ocular surface disease (OSD) in whom a combination approach was used to manage the OSD resulting in improved intraocular pressure (IOP) control.
  
  
  METHODS
  A retrospective review of the clinical notes of 4 patients referred to a tertiary surgical glaucoma service was performed. At the initial visit, measures to control the OSD were employed in all patients; twice-daily lid hygiene measures, a 3-month course of 50 mg daily oral doxycycline, topical carmellose sodium (celluvisc) 0.5% 4 to 6 times daily, and preservative-free equivalents of topical antiglaucoma medications as deemed appropriate, depending on the perceived severity of the OSD.
  
  
  RESULTS
  Patients were reviewed for a maximum of 24 months after intervention. In all patients treatment resulted in a marked symptomatic and clinical improvement in the ocular surface with a reduction in hyperemia, meibomian gland dysfunction and superficial keratopathy. A reduction in the IOP also occurred in all patients, obviating the need for glaucoma drainage surgery during the study period.
  
  
  CONCLUSIONS
  Patients with severe OSD often have glaucoma that is refractive to medical therapy. Furthermore, the surgical success of glaucoma filtering surgery is compromised in patients with scarring and inflammation of the conjunctiva. The term we postulate is "OSD exacerbated glaucoma." This is the first study to suggest that the use of a combination approach comprising medical treatment to manage the OSD in patients with primary open angle glaucoma may lead to an improvement in the IOP control and the management of glaucoma.
authors: University Hospitals Birmingham, Birmingham, UK.
authors: Ruchika
authors: R
authors: Batra
authors: Rajen
authors: R
authors: Tailor
authors: Shabbir
authors: S
authors: Mohamed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use; D003231:Conjunctivitis / Q000188:drug therapy / Q000503:physiopathology*; D004318:Doxycycline / Q000627:therapeutic use; D004337:Drug Carriers / Q000627:therapeutic use; D015352:Dry Eye Syndromes / Q000188:drug therapy / Q000503:physiopathology*; D005141:Eyelid Diseases / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D007634:Keratitis / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000959:Antihypertensive Agents; D004337:Drug Carriers; D002266:Carboxymethylcellulose Sodium; D004318:Doxycycline