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Side Effects: Price to Pay for Lower IOP?

A study highlights the need to question glaucoma patients carefully about the side effects they experience when using topical intraocular pressure lowering medication for the treatment of ocular hypertension or glaucoma, even when they report satisfaction with their treatment. Published in Clinical Ophthalmology, the observational cross-sectional study showed that although 93.7% of patients were satisfied or very satisfied with their glaucoma treatment, 31.4% reported symptoms upon instillation and 57.3% symptoms between instillations.

Ophthalmological examination of 793 treated and stabilised glaucoma patients showed a high frequency of ocular signs: conjunctival hyperaemia (32%), ocular surface disease (42.5%), and positive conjunctival fluorescein staining (10.3%). The most common symptoms reported at instillation were pain or discomfort (21.2%) and blurred vision (7.2%). The most common symptoms reported between instillations were burning (17.4%), crusts on eyelashes (15.9%), red eye (13.1%), photophobia (12.9%), tingling (12.7%), watering (11.9%), itching (9.2%), foreign body sensation (9.0%) and dry eye sensation (5.4%).

The authors noted that 91.5% of study patients were using preserved eye drops, known for their local side effects. This was despite the availability of preservative free treatment options, and that “many side effects decreased when the preserved eye drops were discontinued”. They hypothesised that both ophthalmologists and patients may consider the occurrence of such side effects as “the price to pay” for successfully controlling their intraocular pressure.


Stalmans I, Lemij H, Clarke J, Baudouin C. Signs and Symptoms of Ocular Surface Disease: The Reasons for Patient Dissatisfaction with Glaucoma Treatments. Clinical Ophthalmol. 2020; 14: 3675–3680. doi: 10.2147/OPTH.S269586