Clinical tolerance of antiglaucoma eye drops with and without a preservative

Purpose : To evaluate the clinical tolerance of antiglaucoma eye drops with and without a preservative in routine practice. Methods : A total of 125 ophthalmologists in private practice located throu ghout France examined altogether 919 glaucomatous patients treated with eye drops containing a preservative or not. For some patients the examination was repeated during a second visit. Functional signs as well as conjunctiva l and corneal examination results were recorded. Results : The proportion of patients experiencing discomfort or pain during instillation was 58% for eye drops containing a preservative and 30% for e ye drops with no preservative (p < 0.001). Moreover, the proportion of pati ents presenting at least one symptom of eye irritation (sensation of itchin g or burning, sensation of a foreign body in the eye, and flow of tears) wa s greater with preservative-containing eye drops (53% vs 34%; p < 0.001). T he experience of discomfort during instillation was more often associated w ith problems later on: The patient's complaints were correlated with object ive signs of conjunctival (conjunctival redness, conjunctival follicles) or corneal (superficial punctuate keratitis) damages. A higher proportion of patients treated with eye drops containing a preservative showed at least o ne conjunctival sign (52% vs 35%; p = 0.001) or superficial punctuate kerat itis (12% vs 4%; p = 0.01). In 164 patients, whose treatment was changed fr om eye drops containing a preservative to eye drops with no preservative an d who were examined a second time (mean interval between visits: 3,3 months ) the frequency of all symptoms and objective signs fell by a factor of 3 t o 4 (p < 0.001). Conclusion: Patient complaints and objective damage-to the ocular surface a re more frequent among patients treated with eye drops containing:a preserv ative. Ocular surface damage due to preservatives is partially reversible. Patient complaints should consequently be taken into account and preservati ve-free eye drops should be prescribed when ever possible.