Which statement best describes dry eye in glaucoma patients?

• A. All drugs containing BAK can cause dry eye
• B. Dry eye is not influenced by glaucoma medications
• C. Only prostaglandin analogs cause dry eye
• D. Dry eye is solely due to environmental factors

Answer: (D)

Dry eye in glaucoma patients is shaped by several interacting factors that affect the stability of the tear film and the health of the ocular surface. Chronic use of topical glaucoma drops, especially those with preservatives like benzalkonium chloride (BAK), can disrupt the tear film, cause ocular surface inflammation, and worsen dry eye. Prostaglandin analogs, while effective for lowering intraocular pressure, can also contribute to surface changes and irritation in some patients. At the same time, environmental conditions such as low humidity, dry air, wind, and prolonged screen time increase tear evaporation and worsen symptoms. Because all these elements can play a role, the overall picture is multifactorial rather than caused by a single factor.

Among the given statements, environmental factors are highlighted as a major contributor, which captures a significant and often modifiable aspect of dry eye in glaucoma patients. In real-world practice, addressing environmental conditions (humidification, reducing exposure to dry air, taking breaks during screen use) alongside evaluating the role of preserved glaucoma drops and considering preservative-free formulations can help manage dry eye symptoms effectively.