Topical Glaucoma Treatments May Be Associated With Meibomian Gland Dysfunction

Doctor Examines Patient's Eye in Dark Room with Handheld Lens.
An ophthalmologist shines light into the eye of a tense young female patient who has a piece of foreign object (metal shard) stuck in her cornea. Real injury and examination. A slit lamp instrument for closer examination is in the foreground and lights the doctor’s hand.
Meibomian gland dysfunction can worsen when drops containing preservatives are used, according to a study.

Topical treatments used to treat glaucoma can lead to meibomian gland dysfunction, according to a study published in Optometry and Vision Science.

Investigators assessed meibomian gland dysfunction in 131 eyes of glaucoma patients and 92 eyes of patients with untreated ocular hypertension after administering topical antiglaucoma drugs.

They found that meibomian gland depletion increased in patients with glaucoma after applying the medication ( P <.001). The quantity of meibomian glands and expressibility of meibum were impaired vs the control group (both P <.001). Patients with glaucoma exhibited more corneal staining and the Marx line location score increased in those using benzalkonium chloride as a preservative. On further analysis, Marx line central, Marx line temporal, quantity of meibum expression, and quality of meibum expression was associated with meibomian gland dysfunction–related dry eye disease.

Agents that decrease intraocular pressure can result in adverse effects at the ocular surface, with previous studies showing that long-term treatment impairs the morphology/function of meibomian glands. Meibomian gland damage occurs frequently with glaucoma. Long-term treatment with glaucoma eye drops can lead to lowered tolerability and adherence due to drug exposure replete with preservatives.

The Ocular Surface Disease Index (OSDI) questionnaire revealed that patients with glaucoma reported symptoms more frequently than the control group. However, these findings were not deemed to be statistically significant. 

“In addition to reducing the use of preservatives in glaucoma drugs and artificial lubricants, those patients who require glaucoma treatment could benefit from other types of therapies aimed more specifically at improving meibomian gland dysfunction, such as physical therapies that use heat, intense pulsed light therapy, and even lipid ocular substitutes,” according to the researchers.

Limitations of the current study include the small sample size of participants receiving preservative-free glaucoma treatment, and the subjective interpretation of certain findings. 


Soriano D, Ferrandez B, Mateo A, Polo V, Garcia-Martin E. Changes in open-angle glaucoma users treated with topical medication. Optom Vis Sci. 2021;98(10):1177-1182. doi:10.1097/OPX.0000000000001782