January 05, 2021
1 min read
Patients with glaucoma had significantly higher ocular redness than patients without glaucoma, according to a study published in the European Journal of Ophthalmology.
“Conjunctival redness or hyperemia is one of the most common ocular responses to insults of various origin and can be present in different ocular diseases such as conjunctivitis, dry eye, allergy, infection and contact lens wearing,” Giuseppe Giannaccare, MD, PhD, department of ophthalmology, University of Magna Graecia of Catanzaro, and colleagues wrote. “In patients with glaucoma, conjunctival hyperemia is not only a cosmetic problem but may also reduce patient’s adherence to therapy, thus facilitating disease progression.”
In an observational, cross-sectional study, researchers compared ocular redness scores between 102 patients with glaucoma and 32 patient controls. Using the Oculus Keratograph 5M Topographer, researchers measured global redness scores, nasal bulbar redness scores, temporal bulbar redness scores, nasal limbal redness scores and temporal limbal redness scores. They used multiple linear regression to evaluate the associations between redness scores and the use of active agents.
Study results showed ocular redness scores were higher in patients with glaucoma compared with control patients (P < .001), with the number of active agents associated with all redness scores (P < .05). Carbonic anhydrase inhibitors (Beta = 0.4; P = .4), prostaglandin analogs (Beta = 0.33; P = .013) and alpha-adrenergic agonists (Beta = 0.311; P = .044) best predicted overall redness. Patients using tafluprost and latanoprost showed significantly lower overall redness and bulbar nasal redness compared with patients using travoprost and bimatoprost (Allergan; P = .025 vs. P = .024, respectively).
“Glaucoma patients under topical IOP-lowering medications showed higher global and sectorial scores of ocular redness compared to matched control subjects,” Giannaccare and colleagues concluded. “The number of active principles and the use of prostaglandin analogs, carbonic anhydrase inhibitors and alpha-adrenergic agonists contributed to a higher degree of conjunctival hyperemia.”
Perspective
Conjunctival hyperemia is the most common side effect of topical glaucoma medications. Patients may be sensitive to active ingredients, preservatives or both. While this is largely considered a trivial cosmetic concern, conjunctival hyperemia has been found to directly contribute to poor compliance and may actually contribute to IOP elevation. If your patient is concerned, you should be concerned.
Which class is most likely to make eyes red? After rho-K inhibitors, I would have guessed prostaglandin analogues (PGAs). Giannaccare and colleagues in their observational, cross-sectional study proved me wrong. Carbonic anhydrase inhibitor medications have the highest association with global redness. Interestingly, PGAs were most associated with nasal conjunctival hyperemia. Perhaps this is more troubling than global conjunctival hyperemia. They also confirmed a clinical observation that latanoprost and tafluprost are less likely to cause conjunctival hyperemia than travoprost and bimatoprost. Additionally, their findings suggest that non-benzalkonium chloride preserved medications were not less likely to cause conjunctival hyperemia.
While this study may not strongly impact my practice, we should carefully talk with and examine our patients. Conjunctival hyperemia is an important finding that can influence glaucoma treatment. Finally, please remember to treat ocular surface disease in all patients, but especially glaucoma patients. Everyone wins.
Carl H. Jacobsen, OD, FAAO
University of California Berkeley, School of Optometry
Member, Optometric Glaucoma Society
Disclosures: Jacobsen is on the Alcon speakers bureau and has been an advisor to Sucampo.
