title: Ocular surface disease and glaucoma: how to evaluate impact on quality of life.
abstract: OBJECTIVE
  To record signs and symptoms of ocular surface disease (OSD) in patients treated with Intra Ocular Pressure (IOP)-lowering medications; to evaluate the relationship between signs and symptoms; and to identify how to diagnose and follow OSD and its impact on the quality of life in such patients.
  
  
  METHODS
  A prospective observational study of enrolled consecutive topically treated open-angle glaucoma or ocular hypertension patients: patients presenting systemic or ocular conditions that could interfere with ocular surface status were excluded. Enrolled patients underwent a complete ophthalmic examination comprehensive of evaluation of tear film break-up time (TF-BUT) and fluorescein corneal staining (keratitis punctatae) and who completed the Italian version of both the National Eye Institute-Visual Function Questionnaire (NEI-VFQ) 25 and the Glaucoma Symptom Scale (GSS) questionnaires.
  
  
  RESULTS
  233 patients adhered to a study protocol. Punctatae keratitis was detected in 70 (30%) eyes; abnormal TF-BUT in 67 (28.8%) patients: 97 patients (42.1%) presented an OSD. The abnormal values were gender-independent, keratitis was statistically related to age (P=0.01) and number of instillations/die (P=0.0007). TF-BUT was related to the IOP value (P<0.0001). The NEI ocular pain subscale was statistically related to TF-BUT (P=0.017); GSS was both related to TF-BUT and punctatae keratitis (P<0.00001).
  
  
  CONCLUSIONS
  Many patients present an OSD related to therapy, and this affects their quality of life. The use of fixed combinations to reduce surface exposition and of benzalkonium chloride-free formulations should be encouraged to reduce and contain the onset or worsening of this secondary condition in glaucoma patients. The GSS has shown a good relation to signs and should be routinely used to evaluate the impact of OSD on the quality of life.
authors.affiliation: University Eye Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. gemma.rossi.md@gmail.com
authors.forename: Gemma Caterina Maria
authors.initials: GC
authors.lastname: Rossi
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Pasinetti
authors.forename: Luigia
authors.initials: L
authors.lastname: Scudeller
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Bianchi
mesh_terms: D060433:Administration, Ophthalmic; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001548:Benzalkonium Compounds / Q000009:adverse effects / Q000737:chemistry; D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D007634:Keratitis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects / Q000737:chemistry; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism
chemical_list: D001548:Benzalkonium Compounds; D005456:Fluorescent Dyes; D011310:Preservatives, Pharmaceutical; D019793:Fluorescein