Topical Anti-glaucoma Medications and Lacrimal Drainage System Obstruction

Purpose: To evaluate the effect of topical anti-glaucoma medications on lacrimal drainage system (LDS).Methods: In a prospective controlled blind observational case series, 627 eyes of 384 patients (219 males, 165 females) were studied. Data recording (demographics and history taking), allocation into case (on topical anti-glaucoma medications) and control (no glaucoma) group, and examinations (eye examination and dye disappearance test) were performed by a senior ophthalmology resident. Exclusion criteria were: epiphora prior to onset of treatment with topical anti-glaucoma medication (just for case group), history of long term usage of topical medications (besides anti-glaucoma medications in the case group), previous intraocular surgery, lacrimal surgery, ocular or periocular trauma, radiation therapy, mucous membrane disorder, eyelid margin malposition, and untreated blepharitis. Diagnostic probing and irrigation of lacrimal drainage system were blindly performed by an oculoplastic surgeon.Results: After exclusion, there were 130 eyes from 98 patients and 280 eyes from 178 patients in the case and control group, respectively. Case and control groups were matched. There were significantly more LDS obstruction (LDSO) in the case (26/130, 20%) than control (24/280, 8.57%) group (P=0.002). Upper LDSO was significantly more in the case group (P=0.018). Increasing age was associated with significantly more LDSO in just control group (P=0.029). Significant LDSO was found in the eyes taking Timolol + Dorzolamide (P=0.021) and Timolol + Dorzolamide + Pilocarpine (P=0.017) with duration of 2 weeks to 156 months.Conclusion: Patients on combination of topical anti-glaucoma medications are significantly at risk of developing LDSO. Upper LDSO is significantly more in patients on topical anti-glaucoma drugs