Topical Glaucoma Therapy as a Risk Factor for Nasolacrimal Duct Obstruction

Purpose: To investigate a possible association between primary open-angle glaucoma (POAG) and primary acquired nasolacrimal duct obstruction (PANDO). Design: Retrospective, comparative study. Methods: The study group consisted of 209 consecutive eyes (178 patients) whose lacrimal system had PANDO in patients more than 50 years of age during the 10-year study period. The control group consisted of 183 consecutive eyes (183 patients) that underwent cataract surgery during the same period. The main outcome measures were prevalence of POAG in study and control groups and the effect of topical glaucoma therapy use profile on PANDO prevalence. Medical records of all patients included in the study were reviewed. Data collected included demographic details and history and characteristics of POAG treatment. Results: The prevalence of POAG in the PANDO group (23%) was significantly higher than that of the control group (6%; P < .0001). The average history of POAG was longer in the PANDO group (14.10 ± 5.59 years) compared with the control group (9.55 ± 7.23 years; P = .025). The average number of topical glaucoma therapy drugs per glaucomatous eye in the PANDO group (1.58 ± 0.92) was significantly higher than that of the control group (0.73 ± 0.90; P = .002). Bilateral nasolacrimal duct obstruction (NLDO) was more common among glaucoma patients in the PANDO group (38.23%) compared with nonglaucoma patients in the same group (11.80%; P = .0002). A significantly higher percentage of glaucoma patients in the PANDO group (69%) were treated with timolol, compared with glaucoma patients in the control group (18%; P = .005). Conclusions: Chronic use of timolol-containing topical glaucoma therapy preparations in glaucoma patients is associated with an increased risk for the development of NLDO. Large-scale prospective studies are needed to ascertain this association.