Dry Eye Disease Management Among Glaucoma Patients Based On Mmp-9 Detection.

Dry eye disease is a complex disease causing symptoms affecting the patient quality of life and potentially damaging the ocular surface. Among the risk factors for DED are ocular and systemic medications. In glaucoma patients, although its prevalence was reported to be 48-59%, it is often   underestimated in the effort to manage IOP with either single or multiple hypotensive drops. It is known that these drops in the long term can initiate or exacerbate DED. The purpose of this study was to effectively manage DED in glaucoma patients on topical hypotensive medications following a protocol based on identification.of MMP-9.

Research &Therapeutic Institute “Ophthalmos”, Glyfada, Athens, Greece

15 patients on glaucoma medications were included.   InflammaDry (Rapid Pathogen Screening), a single-use, non-invasive test to detect MMP-9 was performed in all patients as well as Tear film assessment, Break-up-Time (BUT) and corneal staining. All patients filled a Speed questionnaire for evaluation of subjective symptoms. Patients with positive test were randomised to receive preservative-free hydrocortisone 0.335% (Softacort, Laboratories Thea, France) and Thealoz Duo(Thea, France) three times daily or Thealoz Duo only three times daily for 28 days. Ocular redness was assessed at baseline and day 28. Measurement of intraocular pressure (IOP) and clinical tests to assess signs and symptoms of DED were performed on day 15 and 28.

Conjunctival hyperaemia and DED decreased in both treatment groups. We found an increase in tear film thickness and improvement in tear quality which was more significant in the group that had the combination treatment ( Softacort and Thealoz Duo) 4 weeks after treatment start. Subjective symptoms had greater improvement also in the same group.  IOP did not change in either of the two treatment groups (p = 0.37). Inflammadry result was positively correlated with the outcome and resolution of symptoms.

Inflammadry was useful in identifying glauocoma patients under treatment with inflammatory DED , and guided their treatment with low dose hydrocortisone, which also had a good safety profile.  Combination of hydrocortisone and artificial tears had greater impact on subjective and objective improvement of DED and did not affect the intraocular pressure.