Conjunctival changes associated with glaucoma therapy: implications for the external disease consultant and the treatment of glaucoma.

PURPOSE: Enhance recognition by the external disease specialist of the conjunctival changes associated with glaucoma therapy and the reported association with glaucoma filtration surgery.
METHODS: Literature search with emphasis on the cellular and subcellular changes induced by antiglaucoma medications, the definition and diagnosis of drug-induced cicatricial conjunctivitis (DICC), and the implications for future glaucoma therapy or surgery.
RESULTS: Significant conjunctival and subconjunctival changes occur associated with the use of antiglaucoma medications that affect the success of glaucoma filtration surgery. The extreme form of change is the DICC, which is clinically and pathologically identical to ocular cicatricial pemphigoid. The autoantigen in the basement membrane probably differs in these two disease processes.
CONCLUSIONS: There is a movement toward an earlier approach to glaucoma filtration surgery, in large part based on the literature reviewed here. The external disease specialist needs to be cognizant of these conjunctival changes to best consult on patients receiving antiglaucoma medications.