Abstract：
Ocular surface disease (OSD) is a complex condition that can cause a range of symptoms (e.g, dryness, irritation, and pain) and can significantly impact the quality of life of affected individuals. Iatrogenic OSD, a common finding in patients with glaucoma who receive chronic therapy with topical ocular antihypertensive drugs containing preservatives such as benzalkonium chloride (BAK), has been linked to damage to the ocular surface barrier, corneal epithelial cells, nerves, conjunctival goblet cells, and trabecular meshwork. Chronic BAK exposure activates inflammatory pathways and worsens symptoms, compromising the success of subsequent filtration surgery in an exposure-dependent manner. In eyes being treated for glaucoma, symptomatic treatment of OSD may provide some relief, but addressing the root cause of the OSD often necessitates reducing or, ideally, eliminating BAK toxicity. Strategies to decrease BAK exposure in patients with glaucoma encompass the use of preservative-free formulations or drugs with alternative and less toxic preservatives such as SofZia®, Polyquad, potassium sorbate, or Purite®. Though the benefits of these alternative preservatives are largely unproven, they might be considered when financial constraints prevent the use of preservative-free versions. For patients receiving multiple topical preserved drugs, the best practice is to switch to nonpreserved equivalents wherever feasible, regardless of OSD severity. Furthermore, nonpharmacological approaches, including laser or incisional procedures, should be considered. This review explores the effects of BAK on the ocular surface and reviews strategies for minimizing or eliminating BAK exposure in patients with glaucoma in order to significantly improve their quality of life and prevent complications associated with chronic exposure to BAK.
摘要：
眼表疾病（OSD）是一种复杂的疾病，可引起一系列症状（例如，干燥度,刺激,和疼痛），并且可以显着影响受影响个体的生活质量。医源性OSD,在接受含有防腐剂如苯扎氯铵（BAK）的局部眼部抗高血压药物的慢性治疗的青光眼患者中，这是一个常见的发现，与眼表屏障受损有关，角膜上皮细胞，神经,结膜杯状细胞，和小梁网.慢性BAK暴露会激活炎症途径并恶化症状，以暴露依赖的方式损害后续过滤手术的成功。在接受青光眼治疗的眼睛中，OSD的对症治疗可以提供一些缓解，但是解决OSD的根本原因通常需要减少或，理想情况下,消除BAK毒性。减少青光眼患者BAK暴露的策略包括使用无防腐剂的制剂或具有替代且毒性较低的防腐剂的药物，如SofZia®。Polyquad,山梨酸钾，或Purite®。虽然这些替代防腐剂的好处在很大程度上是未经证实的，当财政限制阻止使用不含防腐剂的版本时，可能会考虑它们。对于接受多种局部保存药物的患者，最好的做法是在可行的情况下切换到不保留的等价物，无论OSD严重程度如何。此外，非药理学方法，包括激光或切口手术，应该考虑。这篇综述探讨了BAK对眼表的影响，并回顾了减少或消除青光眼患者BAK暴露的策略，以显着提高其生活质量并预防与长期暴露于BAK相关的并发症。
