Topical glaucoma medication use and development of eyelid malposition and lacrimal obstruction: A population-based study

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Authors: Matthew P. Quinn1, Marlo Whitehead2, Vladimir Kratky1, Sudeep S. Gill1, Robert J. Campbell1. 1Queen's University, 2ICES.

Author Disclosure Block: M.P. Quinn: None. M. Whitehead: None. V. Kratky: None. S.S. Gill: None. R.J. Campbell: None.

Abstract Title: Topical glaucoma medication use and development of eyelid malposition and lacrimal obstruction: A population-based study

Abstract Body:

Purpose: To determine if the use of topical glaucoma medications is associated with subsequent development of eyelid malposition and lacrimal obstruction. Study Design: Longitudinal, observational population-based study using provincial health care databases. Methods: Ontario residents above age 66 were included. In the treatment cohort, patients were included if they had started a topical glaucoma medication between 2002 and 2018 and were previously glaucoma-therapy naïve. Untreated glaucoma suspects (controls) were matched to treated subjects (2:1). Propensity score methods were used to balance potential confounding variables between groups. Outcomes included procedures for eyelid malposition (repair of trichiasis, entropion, ectropion) and for lacrimal obstruction (canalicular intubation, dacryocystorhinostomy [DCR]). Survival analyses were used to estimate hazard ratios for each outcome. Institutional research ethics board approval was obtained. Results: A total of 353,918 patients were included. There were no significant differences between the treated and untreated cohorts in baseline characteristics including age, sex, or medical comorbidity scores. Use of topical glaucoma medication was associated with increased incidence of trichiasis repair (hazard ratio [HR]: 1.69, 95% confidence interval [CI]: 1.52-1.88), entropion repair (HR: 1.24, 95% CI: 1.12-1.37), canalicular intubation (HR: 1.27, 95% CI: 1.01-1.60) and DCR (HR: 1.21, 95% CI: 1.03-1.41). Use of topical glaucoma medication was associated with decreased incidence of ectropion repair (HR: 0.89, 95% CI: 0.81-0.97). Conclusions: Topical glaucoma medications are very commonly prescribed. Higher rates of eyelid disorders and lacrimal obstruction among patients taking these medications have been previously reported in small, cross-sectional studies. In this long-term, longitudinal, population-based study, we found that use of glaucoma medications is associated with increased incidence of surgery for eyelid malposition and lacrimal obstruction. Medication-induced tissue changes such as sub-epithelial fibrosis have been described and may be the underlying mechanism.