Pre-corneal Tear-film Changes after Application of Topical Alpha-agonists and the Dorzolamide-timolol Combination

¹Müller M. F., ¹Pillunat L. E., ¹Böhm A. G., ²Bernd A. S., ¹Köller U. A., ¹Mollenhauer K.,
¹Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Augenheilkunde (Dresden)
²Glaucoma Center, Univ. of California (San Diego)

Purpose: To investigate the short-term influence of fixed combination of dorzolamide and timolol eye drops and topical alpha-agonists apraclonidine and brimonidine on ocular tear film.
Material and methods: 30 healthy subjects (14 male, 16 female; mean age 32years) received in a double masked, cross over design a single dose of the fixed combination of dorzolamide and timolol (DT), apraclonidine (AC) and brimonidine (BR) in one randomly chosen eye. NaCl 0,9% solution served as control. 60 minutes before and 30, 60 and 90 minutes after eye drop application the tear film break up time (BUT) and basal tear secretion (BTS) were determined. For measuring the BUT 10 µl of 0.2% fluorescein solution was used. BTS measurements were obtained by the Schirmer Test. The wilcoxon test for matched pairs was used for statistical analysis.
Results: The baseline results were normalized to 100% due to considerable interindividual variation.

	BUT				bTS
	T-60 min	T+30 min	T+60 min	T+90 min	T-60 min	T+30 min	T+60 min	T+90 min
AC	9,3±10,9	7,0±3,6 (-25)	7,5±4,8 (-19)	6,0±3,3 (-35**)	19,9±9,1	17,9±9,6 (-10)	15,9±9,5 (-20**)	15,5±9,8 (-22**)
BR	12,0±12,0	9,9±6,3 (-17)	10,2±11,1 (-15)	9,6±11,7 (-20*)	21,3±8,0	17,5±7,8 (-18**)	16,5±8,7 (-23**)	14,8±8,1 (-31**)
DT	10,4±7,7	8,6±5,6 (-17)	8,5±5,3 (-18)	6,8±3,8 (-35**)	20,2±9,0	19,5±9,7 (-3)	18,5±9,2 (-8)	18,4±8,7 (-9)
NaCl	8,2±4,7	7,6±5,6 (-7)	8,2±6,5 (±0)	6,4±4,1 (-22*)	19,4±10,2	18,1±9,0 (-7)	16,8±9,5 (-13*)	16,6±9,3 (-14*)

[mean±SD; (x): ΔBUT and ΔBTS in %; *p≤0,05 ; **p≤0,01]
Conclusion: 90 minutes after single dose application of all tested ophthalmic solutions the BUT was significantly reduced, but it was more disturbed after AC and DT. BR diminished basal tear secretion at al points of follow up. However, BTS was also significantly decreased 60 and 90 minutes after AC and NaCl instillation. Surprisingly there was no significant change of BTS in DT treated eyes. The results of this study might be helpful in finding the suitable therapy with regard to the individual tear film situation of glaucoma patients.

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