Download Glaucoma patient complaining of foreign body sensation and eye

Glaucoma patient complaining of
foreign body sensation and eye
irritation
Mehrdad Malihi, M.D., Albert S. Khouri, M.D., Robert D. Fechtner, M.D.
Abstract
History: A 63-year-old woman with open angle glaucoma was evaluated due to chronic dry
eye, irritation, and red eye. Her symptoms worsened by topical IOP-lowering medications, which
resulted in poor medication compliance. Slit lamp examination revealed conjunctival hyperemia
without follicles, decreased tear meniscus, and rapid tear break up time. Lid margin irregularity,
telangiectatic blood vessels coursing from the posterior to anterior eyelid margins and pouting
meibomian gland orifices were noted. Fluorescein dye revealed fine and coarse granular staining
of the inferior cornea. Dilated fundus examination was notable for glaucomatous cupping, and
automated visual-field testing confirmed corresponding dense visual field loss.
Management: She was diagnosed with ocular surface disease due to moderate dry eye
syndrome and posterior blepharitis (meibomian gland dysfunction). A multi-step therapeutic
approach was initiated. Preservative- free tear substitutes were recommended and lid hygiene
measures were emphasized. Reversible occlusion of lacrimal puncta was performed using
punctum plugs. She was placed on less frequent dosing of glaucoma medications, and was finally
started on Restasis OU BID. Over the course of the next few months, patients’ signs and
symptoms improved significantly, her compliance with glaucoma medications improved and her
intraocular pressure were better controlled.
Conclusion: Ocular surface disease is common among elderly patients, and is more frequently
seen in glaucoma patients. Proper diagnosis and management of this condition may have huge
impact on patient quality of life, compliance with therapy, and glaucoma prognosis.