Glaucoma Drops and Dry, Irritated Eyes: Why a Review Calls the Eye Surface an Essential Part of Glaucoma Care

Many people with glaucoma use eye drops every day for years. Those drops protect the optic nerve by lowering eye pressure, but they can also take a toll on the surface of the eye: burning, redness, grittiness, and blurry vision that comes and goes. A narrative review in the Journal of Glaucoma, reported by Healio, argues that checking and protecting the eye surface should be a routine part of glaucoma care.

How common is the problem?

The review’s author, Miriam Kolko, MD, PhD, of the University of Copenhagen, reviewed studies published from 2000 to 2025, along with earlier landmark studies. She reported that 48% to 60% of people with glaucoma have ocular surface disease, compared with about 15% of people without glaucoma.

Why drops can irritate the eye

• Many glaucoma drops contain the preservative benzalkonium chloride (BAK), which has been linked to inflammation, damage to surface cells, and an unstable tear film.
• Long-term use can reduce the mucus-producing cells that help tears spread and can contribute to oil-gland problems.
• Alternative preservatives are gentler but, according to the review, can still stress surface cells. Some active ingredients, such as beta-blockers, may also play a role.

Why it matters for your sight

Eyes that sting and burn make it harder to keep using drops as prescribed, and missed doses can mean poorer pressure control. Dr. Kolko recommended a thorough surface evaluation, including symptom questionnaires, an exam of the front of the eye, simple tear tests, and a medication review. Options to protect the surface include preservative-free or low-preservative drops, selective laser trabeculoplasty, and minimally invasive glaucoma surgery, chosen with each patient through shared decision-making. A commentator added that generic substitution can sometimes switch a patient back to a preserved drop without anyone noticing.

Tips if your glaucoma drops sting

• Do not stop your drops; tell your eye doctor how they feel.
• Ask whether a preservative-free version or a laser option fits your situation.
• Check the label when your pharmacy refills a prescription, and ask if the product has changed.

At Khanna Vision Institute we ask how your drops feel and look at the eye surface during glaucoma visits, because comfort and adherence go together. For appointments and practice details, visit khannainstitute.com.

Source: Ocular surface evaluation ‘essential component’ of glaucoma care (Healio Optometry, 07/31/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.