Objective: To study the frequency and severity of ocular surface disease among glaucoma patients attending
the Eye Clinic of the University College Hospital, Ibadan, Nigeria.
Methods: A hospital-based, cross sectional study was carried out at the Eye Clinic of the University College
Hospital, Ibadan. After a detailed ocular examination, each respondent completed an Ocular Surface Disease
Index (OSDI) questionnaire and performed central visual field assessment. Participants were analyzed for the
effect of anti-glaucoma topical medications (all BAK-preserved) and glaucoma severity on ocular surface disease.
Results: A total of 122 consecutive glaucoma patients were studied. Males accounted for 45.1%. Increasing daily
drops of anti-glaucoma medication was significantly associated with increasing side effects such as redness,
stinging and peppery sensations (p < 0.01). Eighty four patients representing 68.9% had some form of OSD using
the OSDI score. The OSDI scores and the number of patients with OSD significantly increased with increasing
glaucoma severity (p < 0.01).
Conclusion: Ocular surface disease was found to be associated with glaucoma severity and use of BAK-preserved
topical anti-glaucoma medications.
Key words: Benzalkonium chloride, Glaucoma, Ibadan, Ocular surface disease
The definition and classification of dry eye
disease: report of the Definition and Classification
Subcommittee of the International Dry Eye
Workshop. Ocul Surf. 2007; 5(2):75–92.
Pflugfelder SC. Prevalence, burden and
pharmacoeconomics of dry eye disease. Am J Manag
Care. 2008; 14(3 Suppl):S102-S106.
Smith JA. The epidemiology of dry eye disease:
report of the Epidemiology Subcommittee of the
International Dry Eye WorkShop. Ocul Surf. 2007;
Brewitt H, Sistani F. Dry eye disease: the scale of
the problem. Surv Ophthalmol. 2001; 45(Suppl 2):
Mathers WD, Choi D. Cluster analysis of patients
with ocular surface disease, Blepharirtis and dry eye.
Arch Ophthalmol. 2004; 122(1):1700-1704.
Leung EW, Medeiros FA, Weinreb RN. Prevalence
of ocular surface disease in glaucoma patients.
J Glaucoma. 2008; 17(5): 350-355.
Quigley H, Browman AT. The number of people
with glaucoma worldwide in 2010 and 2020. Br J
Ophthalmol. 2006; 90(3): 267-267.
Friedman DS, Wolfs RC, O’Colmain BJ, Klein BE,
Taylor HR, West S, et al. Prevalence of open-angle
glaucoma among adults in the United States. Arch
Ophthalmol. 2004; 122(4): 532-538.
Klaver CC, Wolfs RC, Vingering JR, Hofman A,
de Jong PT. Age-specific prevalence and causes
of blindness and visual impairment in an older
population: the Rotterdam Study. Arch Ophthalmol.
Pizzarello LD. The dimensions of the problems of
eye disease among the elderly. Ophthalmology.
Stewart WC, Stewart JA, Nelson LA. Ocular surface
disease in patients with ocular hypertension and
glaucoma. Curr Eye Res. 2011; 35(5):391-398.
Wilson WS, Duncan AJ, Jay JL. Effect of
benzalkonium chloride on the stability of the
precorneal tear film in rabbit and man. Br J
Ophthalmol. 1975; 59:667-669
Baudouin C, de Lunardo C. Short-term comparative
study of topical 2% carteolol with and without
benzalkonium chloride in healthy volunteers. Br J
Ophthalmol. 1998; 82:39-42.
Yee RW. The effect of drop vehicle on the efficacy
and side effects of topical glaucoma therapy: a
review. Curr Opin Ophthal. 2007; 18: 134-139.
Herreras JM, Pastor JC, Calonge M. Ocular
surface alteration after long term treatment with
an antiglaucomatous drug. Ophthalmology. 1992;
Baudouin C, Labbe A, Liang H, Pauly A, Brignole-
Baudouin F. Preservatives in eyedrops: the good,
the bad and the ugly. Prog Retin Eye Res. 2010;
Skalicky SE, Goldberg I, McCluskey P. Ocular
surface disease and quality of life in patients with
glaucoma. Am J Ophthalmol. 2012; 135(1):1–9.
Schiffman RM, Christianson MD, Jacobsen G,
Hirsch JD, Reis BL. Reliability and validity of the
ocular Surface Disease Index. Arch Ophthalmol.
Garcia-Feijo J, Sampaolesi JR. A multicenter
evaluation of ocular surface disease prevalence in
patients with glaucoma. C. Ophthalmol. 2012; 6:
Barisic F, Krolo I, Popovic-Suic S, Sesar I, Simic-
Prskalo M, et al. Prevalence of Ocular Surface
Disease in Patients with Glaucoma using Topical
Antiglaucoma Medications. J Clin Exp Ophthalmol.
; 5:334. doi: 10.4172/2155-9570.1000334.
Katz G, Springs CL, Craven ER, Montecchi-Palmer
M. Ocular surface disease in patients with glaucoma
or ocular hypertension treated with either BAKpreserved
latanoprost or BAK-free travoprost. Clin
Ophthalmol. 2010; 4:1253-1261.