Association between the use of prostaglandin analogues and ocular surface disease: a systematic review

Patients with glaucoma often experience chronic ocular surface diseases, potentially underestimated in frequency and severity. To provide updated estimates of ocular surface diseases linked to prostaglandin analogue antiglaucoma eye medication, a systematic review was conducted. Twenty-seven publications were selected from databases like PubMed, Scopus, and Web of Science, following a search strategy targeting glaucoma and prostaglandins while excluding certain medications ‘(Glaucoma AND prostaglandins OR ‘prostaglandin analogues’)(‘eye drops’ OR ‘artificial tears’ OR ‘ocular surface’ OR ‘dry eye’ OR ‘dry eye syndrome’ OR ‘ocular surface disease’ OR ‘tear film’) NOT (‘beta blockers’ OR ‘alpha adrenergic agonists’ OR ‘carbonic anhydrase inhibitors’ OR ‘rho-quinase’)’. The review revealed a correlation between prostaglandin analogue use and ocular surface damage, assessing parameters such as tear break-up time, Schirmer test value, ocular surface staining, hyperaemia score, and meibomian gland characteristics. Some studies explored switching patients to alternative glaucoma medications, noting varied effects on ocular surface parameters. Comparisons suggested better tolerance and outcomes with preservative-free options over prostaglandins. Additionally, the impact of treatment duration and diquafosol on ocular health, including meibomian gland loss, was examined across different formulations. Although a link between prostaglandin analogues (with or without preservatives) and ocular surface damage was established, inconsistencies in methodologies and assessment across studies were noted. This comprehensive review, spanning a decade of glaucoma research, underscores the need for re-evaluation of treatment strategies in ophthalmology. It stresses the significance of informed decision-making for enhanced glaucoma care, taking into account the observed effects of various medications on eye health.