Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Do topical ocular antihypertensives affect Dacryocystorhinostomy outcomes: The Coventry experience

Abstract

Background

It has been suggested that ocular antihypertensives are associated with an increased risk of nasolacrimal duct obstruction. This study aims to assess the effect of topical antihypertensive treatment on surgical outcomes for patients undergoing Dacryocystorhinostomy (DCR) with intubation.

Methods

Single centre, retrospective analysis of 170 operations carried out on 144 patients between January 2014 and January 2019. Statistical analysis of DCR failure rates comparing patients on topical ocular antihypertensive treatment and those not on any topical ocular antihypertensive treatment was carried out following medical case record analysis.

Results

6.9% of patients undergoing DCR surgery were on topical antihypertensive treatment. The overall failure rate for all DCR operations during this time period was 11.2%. There was a statistically significant higher rate of primary DCR failure in patients on antihypertensive treatment (p = 0.02), with the endonasal DCRs worse affected (p = 0.01). The most commonly used topical treatments were carbonic anhydrase inhibitors (CAI, 81.8%), followed by beta-blockers (72.7%). All patients who had failure of primary DCR were using topical beta-blockers and CAI at the time of surgery and post-operatively. There was no statistically significant association between failure rates and the use of preserved or unpreserved drops (p = 1.0)

Conclusions

Topical ocular antihypertensive treatment may lead to a higher failure rate for DCR surgery due to the provocation of an inflammatory cicatricial response. Beta-blockers and CAIs appear to have the strongest association. Considering a primary external approach in this group as well as switching the class of topical antihypertensive treatment pre-operatively could perhaps improve DCR outcomes.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 1. Ophthalmic Plast Reconstr Surg. 1992;8:237–2.

    CAS  Article  Google Scholar 

  2. Kashkouli MB, Sadeghipour A, Kaghazkanani R, Bayat A, Pakdel F, Aghai GH. Pathogenesis of primary acquired nasolacrimal duct obstruction. Orbit. 2010;29:11–5.

    Article  Google Scholar 

  3. Inoue K. Managing adverse effects of glaucoma medications. Clin Ophthalmol. 2014;8:903–13.

    CAS  Article  Google Scholar 

  4. Servat JJ, Bernardino CR. Effects of common topical antiglaucoma medications on the ocular surface, eyelids and periorbital tissue. Drugs Aging. 2011;28:267–82.

    CAS  Article  Google Scholar 

  5. Fritsch PO, Sidoroff A. Drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis. Am J Clin Dermatol. 2000;1:349–60.

    CAS  Article  Google Scholar 

  6. Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on Stevens-Johnson syndrome and toxic epidermal necrolysis. Clin Rev Allergy Immunol. 2018;54:147–76.

    CAS  Article  Google Scholar 

  7. Munshi V, Ahluwalia H. Erythema multiforme after use of topical dorzolamide. J Ocul Pharm Ther. 2008;24:91–3.

    CAS  Article  Google Scholar 

  8. Asensio-Sánchez VM. Toxic epidermal necrolysis following dorzolamide eyedrops. Med Interna. 2008;25:47–8.

    Google Scholar 

  9. Chun JS, Yun SJ, Lee JB, Kim SJ, Won YH, Lee SC. Toxic epidermal necrolysis induced by the topical carbonic anhydrase inhibitors brinzolamide and dorzolamide. Ann Dermatol. 2008;20:260–2.

    Article  Google Scholar 

  10. Yang MS, Lee JY, Kim J, Kim GW, Kim BK, Kim JY, et al. Searching for the culprit drugs for Stevens-Johnson syndrome and toxic epidermal necrolysis from a nationwide claim database in Korea. J Allergy Clin Immunol Pract. 2020;8:690–5.e2.

    Article  Google Scholar 

  11. Broadway DC, Grierson I, O’Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol. 1994;112:1446–54.

    CAS  Article  Google Scholar 

  12. Landers J, Martin K, Sarkies N, Bourne R, Watson P. A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology. 2012;119:694–702.

    Article  Google Scholar 

  13. Seider N, Miller B, Beiran I. Topical glaucoma therapy as a risk factor for nasolacrimal duct obstruction. Am J Ophthalmol. 2008;145:120–3.

    CAS  Article  Google Scholar 

  14. Kashkouli MB, Rezaee R, Nilforoushan N, Salimi S, Foroutan A, Naseripour M. Topical antiglaucoma medications and lacrimal drainage system obstruction. Ophthalmic Plast Reconstr Surg. 2008;24:172–5.

    Article  Google Scholar 

  15. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040. Ophthalmology. 2014;121:2081–90.

    Article  Google Scholar 

  16. Dart J. Corneal toxicity: the epithelium and stroma in iatrogenic and factitious disease. Eye. 2003;17:886–92.

    CAS  Article  Google Scholar 

  17. Tekin S, Seven E, Batur M. Evaluation of antiglaucomatous drops on conjunctival thickness in patients with primary open-angle glaucoma. J Ocul Pharm Ther. 2019;35:216–22.

    CAS  Article  Google Scholar 

  18. Hegde V, Robinson R, Dean F, Mulvihill HA, Ahluwalia H. Drug-induced ectropion: what is best practice. Ophthalmology. 2007;114:362–6.

    Article  Google Scholar 

  19. Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29:312–34.

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the conception of the study, data analysis, revision of the manuscript and approval of the final version. Both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Priyanka Mandal.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mandal, P., Ahluwalia, H. Do topical ocular antihypertensives affect Dacryocystorhinostomy outcomes: The Coventry experience. Eye 36, 135–139 (2022). https://doi.org/10.1038/s41433-021-01468-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-021-01468-3

Further reading

Search

Quick links