Optimizing the Ocular Surface Before, During, and After Glaucoma Surgery: A Narrative Review

This narrative review synthesizes the published literature on ocular surface disease (OSD) and glaucoma filtration surgery to develop practical, evidence-informed clinical and surgical recommendations for optimizing ocular surface management before, during, and after surgery. The reviewed studies examine how OSD affects ocular inflammation and wound healing, how chronic preservative-containing topical therapy affects bleb survival, and how reducing cumulative preservative load benefits ocular surface health. In patients with glaucoma, chronic use of preservative-containing topical medications can aggravate OSD, with approximately 50% of patients receiving topical intraocular pressure-lowering therapy reporting symptoms of OSD. OSD-related inflammation and tissue changes may adversely affect wound healing and compromise the success of glaucoma filtration surgery. OSD in patients likely to require filtration surgery should be actively identified and treated throughout the preoperative, intraoperative, and postoperative stages. Practical steps include screening for OSD, reducing exposure to preservative-containing medications, optimizing the ocular surface preoperatively, and minimizing conjunctival inflammation perioperatively. These strategies can be readily adopted into clinical practice and may help optimize conditions for bleb survival, although direct evidence demonstrating improved bleb survival is limited.