INTERACTIVE CASE STUDY: Treatment of glaucoma medications without preservatives – current trend
The use of glaucoma medications without preservatives has been a trend in recent years. You can try their clinical application in the role of a prescribing doctor in an interactive case study. Practical information about this popular local treatment is based on the evidence-based medicine foundation, provided by its author MUDr. Petr Výborný, CSc., from the Eye Clinic of the 1st Faculty of Medicine, Charles University and University Military Hospital in Prague.
A) Basic information about the observed case
A 55-year-old woman, treated for 5 years at another ophthalmology clinic for bilateral primary open-angle glaucoma. She was on therapy with a beta-blocker containing a preservative, applied twice daily. She comes to our glaucoma clinic for a consultation to get a so-called second opinion.
Subjectively, she reports a feeling of eye irritation, sometimes a feeling of sand in the eyes, redness of the eyelids, and hyperemia. The difficulties have appeared in the last approximately 6 months, worse in the morning and evening, lasting about an hour after applying the drops.
Right eye visual acuity 5/7.5 naturally, with correction -1.5 5/5
Left eye visual acuity 5/7.5 naturally, with correction -1.5 5/5
Intraocular pressure compensated with therapy, applanation 15/15 mmHg.
Optical coherence tomography (OCT):
right eye - segment TI „outside normal limit“, left eye segment TI „outside normal limit“,
all other segments of both eyes are normal when compared with the normative database.
Perimeter: normal visual field range for both eyes, only insignificant bilateral MB expansion.
Gonioscopy: chamber angles open, free, without goniosynechiae.
External and intraocular findings are normal, optic nerve heads without glaucomatous changes.
Schirmer's test is normal.
Diagnosis: chronic simple glaucoma bilaterally, mild myopia bilaterally, chronic conjunctivitis bilaterally.
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