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Prevalence of signs and symptoms of ocular surface disease in subjects treated for glaucoma with and without pseudoexfoliation

Poster Details

First Author: A.Matsou GREECE

Co Author(s): M. Dermenoudi   C. Keskini   P. Brazitikos   E. Anastasopoulos           

Abstract Details


Anti-glaucoma medications are widely used in glaucoma management but the favorable effects of treatment are sometimes counterbalanced by the side effects on ocular surface and tear film function. Pseudo-exfoliation (PEX) has been implicated in more severe impairment of tear secretion due to deposition of the material in anterior segment structures including goblet cells and accessory lacrimal glands, thus allegedly rendering PEX and PEX-glaucoma (PEXG) patients more prone to dry eye disease. The purpose of this prospective case series was to evaluate the prevalence of signs and symptoms of ocular surface disease in patients receiving IOP-lowering medication for PEXG and non-PEXG.


2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece


Patients presenting in the glaucoma clinic of our department were prospectively examined for signs of ocular surface disease by means of clinical evaluation of severity of eyelid redness, conjunctival hyperemia, fluorescein conjunctival staining, tear film break-up time (TFBUT), fluorescein corneal staining, and questioned for symptoms using the OSDI (ocular surface disease index) questionnaire.


Ninety-one (91) eyes of 91 patients were prospectively enrolled (mean age 72 years). 58 (63.7%) patients had non-PEXG and 33 (36.3%) had PEXG. Signs of ocular surface disease were prominent in both groups: conjunctival hyperaemia 86.8%, eyelid redness 79.1%, conjunctival staining 81.3%, corneal staining 85.7%, abnormal TFBUT 87.9%. Severity of eyelid redness(non-PEXG 70.7%, PEXG 93.9%, p=0.009) and conjunctival staining (non-PEXG 74.1%, PEXG 93.9%, p=0.025) were the only clinical signs found to differ significantly between groups. Age (non-PEXG 66.71, PEXG 76, p<0.001) and number of preserved drops [non-PEXG median 1, PEXG median 2, p<0.001] were also statistically different between groups.


Pseudo-exfoliation has been traditionally considered to compromise tear secretion and stability, making PEXG patients more prone to xerophthalmic manifestations. In our short case-series, the vast majority of patients in both groups suffered clinically significant ocular surface disease, with eyelid redness and conjunctival fluorescein staining being the only objectively assessed clinical signs that differed significantly between PEXG and non-PEXG patients, with the former exhibiting more severe disease.

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