Glaucoma and Dry Eye: What's the Relationship?
January is Glaucoma Awareness Month
I want to take some time to discuss how glaucoma and dry eye are related. You probably already know what dry eye is. You know that it's an irritation of the front surface of the eye that can cause your eyes to be red, gritty, and irritated.
What is glaucoma?
Glaucoma is often referred to as the "silent thief of vision". It is a disease that causes you to lose your peripheral vision. It generally happens very slowly over a long period of time, This loss of vision is caused by an increase in the pressure inside the eye. The increase in pressure is usually not enough to cause pain.
There are very few symptoms that indicate to a patient that they are suffering from glaucoma. It can go on for years undetected by the person suffering from it until their vision becomes very narrowed. This is exactly why we really encourage people to get eye exams once a year, to check for glaucoma and other silent sight-threatening diseases.
How is Glaucoma Treated?
Once Glaucoma is detected, your doctor will monitor 3 things:
1. your eye pressure
2. your peripheral vision
3. the health of your optic nerves
Treating glaucoma is based on lowering the pressure in the eye and there are several ways to lower eye pressure.
The most common first-line treatment to lower eye pressure in glaucoma patients involves using topical eye drops. There are 5 different categories of eye drops which lower eye pressure, so there are many to choose from. Other forms of glaucoma treatment include laser surgeries, implantable medications, oral medications, implantable stents, minimally invasive glaucoma surgeries, and more significant glaucoma surgeries. There are many ways to treat glaucoma depending on your level of disease and response to medications.
What if My Glaucoma Treatment Makes My Eyes Red?
Like many medications, glaucoma eye drops have side effects. One of the most common side effects of glaucoma medications is eye redness. This is a normal side effect of the medications, and unfortunately, not much can be done about it. Try speaking with your doctor about alternative medications or treatments to eliminate the redness.
If you have glaucoma, you may also notice dry, itchy, stingy, burning, watery, or irritated eyes. These are symptoms of dry eye, and part of your glaucoma treatment may be causing or exacerbating these dry eye symptoms.
What Can You Do About Glaucoma and Dry Eyes?
Please check with your glaucoma doctor about alternative medications and treatments for the ones you are currently taking. Glaucoma is a serious eye disease. Decisions about your treatment should be made with the doctor treating your disease. If you have glaucoma, please make sure you're following up regularly with your eye doctor.
Treat Your Dry Eye Symptoms First
If you're suffering from redness and irritation with your glaucoma medications you may have some underlying dry eye. The best way to start treating your dry eyes is by using a simple four step process. I've reviewed this process many times before. Check out this blog for all the details. The steps consist of lid scrubs, warm compresses, artificial tears, and a dietary supplement for dry eye that will help give your body the building blocks it needs for healthy tears.
Those are the four steps that I always recommend my dry eye patients to start off with. If you have glaucoma, you can just add this to your glaucoma treatment regimen and get some relief with these four simple steps.
Oftentimes, patients with glaucoma suffer from irritation because of the preservatives that are in their glaucoma medications. There are several ways to alleviate this problem. Let's go over each one separately.
Change the Preservative
Glaucoma is a long-term disease, and you may be on eye drop treatment for long periods of time. The preservatives in the medications can cause irritation to your eyes. One of the most common preservatives that we find in prescription glaucoma medications is BAK, benzalkonium chloride. This preservative can be quite irritating to the eyes over time.
One way to fight this or combat this would be to switch to a drop that is BAK free. Xelpros is a prescription glaucoma drop that has been on the market since 2018, and it is BAK free. It does contain the preservative Potassium sorbate. It's a once a day glaucoma drop, which helps to lower your eye pressure, but it does not contain BAK. That might be a good option if you are starting to notice that irritation.
Try a Preservative-Free Eye Drop
You could also switch your glaucoma eye drops to ones that are completely preservative-free. In the last few years, there have been several new drugs developed that are preservative-free. Your usual glaucoma medications that you've already been taking may now be available in a preservative-free formulation.
Zioptan is a preservative-free prescription glaucoma medication. It is in the Prostaglandin-analog family of glaucoma medications. And, it would be a replacement for latanoprost, Xalatan, Lumigan, and Travatan. These are all medications that you'd take once a day at bedtime.
There are also preservative-free versions of Timolol and Cosopt. If you have glaucoma, and are struggling with eye irritation, talk to your eye doctor about switching to a medication that's preservative-free.
There are some differences in using a preservative-free medication that you should be aware of. Some of these medications need to be refrigerated because they are preservative-free. Also, these drops tend to be a bit more expensive than the ones with preservatives.
Use an Implantable Medication
Durysta is a new medication that's implanted into the eye. It's not an eye drop, it is a sustained-release implant that dissolves slowly in the eye. This is a procedure that you would need to have done at your doctor's office.
It can lower your eye pressure significantly so that you would not need to take other topical drops to lower the pressure. The implant will slowly release medication into your eye and it can control your eye pressure for 6 to 12 months.
Durysta was launched in 2020, and many eye doctors are offering it as an option to their patients who have trouble remembering to take their drops or who may be experiencing a lot of irritation with their eyedrops.
Glaucoma Surgery
There are glaucoma surgical procedures that can be done to reduce the number of topical glaucoma medications that you're taking. These procedures range from laser procedures that are performed in the eye doctor's office, to stents inserted during routine cataract surgery, to minimally invasive glaucoma surgeries, to more robust glaucoma surgeries.
The best way to know if glaucoma surgery is the right treatment for you is by speaking with your eye doctor about alternatives to your current glaucoma treatment.
Conclusion
Glaucoma is a sight-threatening disease that should be taken very seriously. Glaucoma itself has very few symptoms to a patient. It is important to have your eyes examined at an eye doctor's office once a year to ensure you are not developing this "silent thief of vision".
If your glaucoma therapy is causing irritation to your eyes, speak with your eye doctor about changing treatment regimens. There are many ways to alleviate the irritation you are experiencing. You could switch to a drop with less irritating preservatives, go with a preservative-free drop, have a sustained-release implant procedure, or undergo some kind of glaucoma surgery.
The most important part is that you treat your eye irritation. It may be a sign of dry eyes. Check out this blog to learn the four simple steps to get your eye dryness under control.
Glaucoma is a long-term disease that will require constant treatment and care. Do not change your treatment regimen on your own because you are experiencing side-effects from your eye drops. Instead, speak to your doctor about the many alternatives available to keep your eyes more comfortable.
