Delhi Journal of Ophthalmology

Effects Of Long-Term Use of Topical Antiglaucoma Drugs on Ocular Surface: A Cross Sectional Study

Aparajita Richhariya1, Anshu Sahai1, Mohammad Abid Shamshad1, Pukhrambam Ratan Kumar1, Maryem Ansari2
1Department of Ophthalmology, Sahai Hospital and Research Centre, Jaipur, Rajasthan, India
2Department of Pathology, Pandit Deen Dayal Upadhyay Hospital Jaipur, Rajasthan, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.

Corresponding Author:

Aparajita Richhariya 
DOMS, DNB Resident
Department of Ophthalmology, Sahai Hospital and Research Centre, Jaipur, Rajasthan, India
Email :

Received: 02-JAN-2022 Accepted: 24-MAR-2022 Published Online: 03-APR-2022

Purpose: Glaucoma is a chronic progressive disease and a major risk factor for blindness. This study aimed to evaluate the long-term effects of topical antiglaucoma drugs on ocular surface.

Methods: This was a cross-sectional study, which included patients with glaucoma who had been taking one/two/three topical drugs (minimum 3 months) and control group of newly diagnosed glaucoma (10 months). The patients were divided into test groups A1 (timolol 0.5%/ briminodine 0.1%/ bimatoprost 0.01%), A2 (dual combination of any of the above drugs), A3 (triple combination) and control. Schirmer-I, tear film breakup time (TBUT), rose bengal, conjunctival impression cytology and ocular surface disease index (OSDI) scores were evaluated.

Results: A total of 164 patients were enrolled and divided into groups A1, A2, A3 and control, respectively. There was a significant difference in Schirmer’s test (mm) results between the groups (15.06, 13.77, 11.24 and 21.26 in A1, A2, A3 and control, respectively; p<0.001). The mean TBUT (seconds) was 9.84, 8.25, 5.29 and 12.33 in A1, A2, A3 in control group, respectively (p<0.001 timolol 0.5% plus briminodine 0.1% plus bimatoprost 0.01%). Abnormal rose bengal was higher in A2 and A3 than A1 (3.94, 5.92 and 2.55, respectively; p<0.001). The mean conjunctival impression cytology grades were more severe in subgroups A1 (1.83), A2 (1.70) and A3 (2.74) than control group (0.96). The mean OSDI scores were significantly (p<0.001) higher in A2 (34.62) and A3 (49.63) than A1 (25.93).

Conclusion: Topical antiglaucoma drugs caused OSD on long term use. The severity of OSD was higher in multiple drug combinations in comparison to single drug. 

Keywords :Bimatoprost, Brimonidine, Conjunctival Impression Cytology, Glaucoma, Ocular Surface Disease, Rose Bengal, Schirmer-I