Patients with glaucoma are at high risk for developing dry eye disease (DED)¹, with 40–59% of patients with glaucoma being diagnosed with DED worldwide².

DED in glaucoma is multifactorial and can be both iatrogenic and co-morbid². As a comorbidity, DED occurs due to decreased tear production from chronic inflammation and increased tear evaporation from meibomian gland dysfunction². Subsequently, the cumulative effect of medications, preservatives and excipients in glaucoma treatment can alter underlying cellular structures (Fig 1), resulting in iatrogenic tear film abnormalities and instability².

Ocular surface inflammation may manifest as early as three months after initiation of anti-glaucoma therapy³, accompanied by the ocular side effects of glaucoma medications (eg. stinging, burning, itching, redness) ⁴. These side effects pose significant barriers to patient adherence² and, in turn, poor adherence increases the risk for glaucoma progression⁵. Furthermore, the severity of toxic or allergic reactions to topical anti-glaucoma medications is related to the number of daily drops, the duration of treatment and the presence of preservatives, as preservatives in glaucoma medication can also negatively impact the ocular surface^6-9.

Systane Hydration Preservative-free

One option to manage dry eye symptoms for patients with glaucoma is Systane Hydration Preservative-free lubricant eye drops. Systane Hydration Preservative-free combines HA* with Alcon’s unique formulation of HP-Guar and borate which crosslink to form a meshwork to increase the retention of demulcents¹⁰.

Systane Hydration Preservative-free creates a moisture layer that provides increased hydration, with 2x better protection against dryness compared with hyaluronic acid alone¹¹, increased tear break-up time compared to lubricating eye drops containing HA alone¹² and 2x the lubricity compared to HA alone¹¹. By providing superior moisture retention, Systane Hydration Preservative-free supports ocular surface healing and corneal re-epithelialisation^13**.

Systane Hydration Preservative-free provides long-lasting, effective relief from DED symptoms in patients with glaucoma and can be considered as part of their dry eye management plan^11,14,15.

References:

1. Kuze M, Ayaki M, Yuki K, et al. Seasonal variation of intra-ocular pressure in glaucoma with and without dry eye. Sci Rep. 2020;10(1):13949.
2. Nijm LM, De Benito-Llopis L, Rossi GC, Vajaranant TS, Coroneo MT. Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review. Asia-Pac J Ophthalmol. 2020;9(6):481-490.
3. Leung EW, Medeiros FA, Weinreb RN. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma. 2008;17(5):350-355.
4. Skalicky SE, Goldberg I, McCluskey P. Ocular surface disease and quality of life in patients with glaucoma. Am J Ophthalmol. 2012;153(1):1-9.e2.
5. Chambard C, Larrieu S, Baudouin C, Bron A, Villain M, Daien V. Preservative-free versus preserved glaucoma eye drops and occurrence of glaucoma surgery. A retrospective study based on the French national health insurance information system, 2008-2016. Acta Ophthalmol (Copenh). 2020;98(7):e876-e881.
6. Newman-Casey PA, Robin AL, Blachley T, et al. Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey. Ophthalmology. 2015;122(7):1308-1316.
7. Mastropasqua R, Agnifili L, Mastropasqua L. Structural and Molecular Tear Film Changes in Glaucoma. Curr Med Chem. 2019;26(22):4225-4240.
8. Van Went C, Alalwani H, Brasnu E, et al.[Corneal sensitivity in patients treated medically for glaucoma or ocular hypertension]. J Fr Ophtalmol. 2011;34(10):684-690.
9. Wong TT, Zhou L, Li J, et al. Proteomic profiling of inflammatory signaling molecules in the tears of patients on chronic glaucoma medication. Invest Ophthalmol Vis Sci. 2011;52(10):7385-7391.
10. Springs C. Novel Ocular Lubricant Containing an Intelligent Delivery System: Details of its Mechanism of Action. Dev Ophthalmol 2010; 45:139-147.
11. Rangarajan R, Kraybill B, Ogundele A, Ketelson HA. Effects of a Hyaluronic Acid/Hydroxypropyl Guar Artificial Tear Solution on Protection, Recovery, and Lubricity in Models of Corneal Epithelium. J Ocul Pharmacol Ther Off J Assoc Ocul Pharmacol Ther. 2015;31(8):491-497.
12. Fluorescein tear break-up time was measured following fluorophotometry assessment. Based on measurement of eye drop retention time using a fluorophotometer; Alcon data on file, 2024 [Doc. No. REF-23973, p. 5]
13. Ogundele A, Kao W, Carlson E. Impact of Hyaluronic Acid Containing Artificial Tear Products on Re-epithelialization in an In Vivo Corneal Wound Model. Poster presented at: 8th International Conference on the Tear Film & Ocular Surface; September 7, 2016; Montpellier,France.
14. Davitt WF, Bloomenstein M, Christensen M, Martin AE. Efficacy in patients with dry eye after treatment with a new lubricant eye drop formulation. J Ocul Pharmacol Ther Off J Assoc Ocul
15. Rolando M, Autori S, Badino F, Barabino S. Protecting the ocular surface and improving the quality of life of dry eye patients: a study of the efficacy of an HP-guar containing ocular lubricant in a population of dry eye patients. J Ocul Pharmacol Ther Off J Assoc Ocul Pharmacol Ther. 2009;25(3):271-278

Helen Gleave is the senior professional education and development manager for Alcon Vision Care ANZ

*Systane® HYDRATION Lubricant Eye Drops contain sodium hyaluronate, the salt form of hyaluronic acid.

**Based on an animal model

© 2025 Alcon Laboratories Pty Ltd. AUS: 1800 224 153; Auckland NZ: 0800 101 106 ANZ-SYY-2500013