The Impact of Glaucoma on the Ocular Surface

Glaucoma is a chronic optic neuropathy typically treated by lowering of the intraocular pressure, through surgery or topical medications. While essential for preserving vision, surgery and topical medications can induce or exacerbate Ocular Surface Disease (OSD). The primary culprit is often not the active medication itself, but the preservatives used in the formulation, most notably benzalkonium chloride (BAK). Chronic exposure to BAK triggers a toxic and inflammatory cascade on the ocular surface. It disrupts the tear film's lipid layer, leading to excessive evaporation and hyperosmolarity. Furthermore, these preservatives induce cell death in the corneal epithelium and destroy conjunctival goblet cells, which are crucial for mucin production. Consequently, patients frequently suffer from burning, redness, and severe dry eye. This vicious cycle of inflammation and surface damage compromises the patient's quality of life and can significantly reduce their compliance with vision-saving glaucoma therapy.The management of glaucoma is challenged by treatments inflicting OSD, which in turn drives patient non-compliance and subsequent surgical failure. This Research Topic aims to address the critical challenge of optimizing intraocular pressure (IOP) control while simultaneously protecting and restoring the ocular surface. The primary problem we wish to tackle is iatrogenic inflammation, tear film instability, and epithelial damage caused by chronic exposure to topical medications and preservatives.To resolve this, the clinical paradigm must evolve. We seek to highlight recent advances that offer tissue-sparing alternatives and proactive OSD management. This includes exploring the expanding role of preservative-free medical therapies, the advent of sustained-release intraocular drug delivery systems, and the increasing utilization of minimally invasive glaucoma surgery (MIGS) and selective laser trabeculoplasty (SLT) to effectively reduce the daily drop burden. By consolidating current research on these innovations, this collection aims to provide actionable strategies to reduce iatrogenic inflammation, enhance treatment adherence, and ultimately improve both long-term visual outcomes and patient quality of life.This Research Topic welcomes contributions that explore the critical intersection of glaucoma management and ocular surface health. We invite researchers and clinicians to submit articles covering, but not limited to, the following themes:• Clinical outcomes and ocular surface biomarkers comparing preservative-free versus preserved topical therapies.• The impact of filtration surgeries, MIGS, SLT and sustained-release drug implants on OSD metrics and patient adherence.• Novel diagnostic tools and proactive screening protocols for identifying high-risk OSD patients in glaucoma clinics.• Pathophysiological mechanisms of medication- or surgery-induced conjunctival and corneal toxicity.• Therapeutic strategies to optimize the ocular surface prior to traditional filtration surgeries to improve long-term bleb survival.We are particularly interested in receiving original research, comprehensive reviews and clinical trials that provide evidence-based solutions to mitigate the burden of iatrogenic OSD in the glaucoma patient population. Topic editors: Fredrik Fineide, Miriam Kolko, Barbara Cvenkel Source: https://www.frontiersin.org/research-topics/83192/the-impact-of-glaucoma-on-the-ocular-surface