Limbal stem cell deficiency secondary to topical glaucoma medication: a scoping review

This scoping review aims to focus on the association between topical anti-glaucoma medication and limbal stem cell deficiency through a comprehensive analysis from the available relevant case reports, research articles and experimental studies. By understanding the potential risks associated with long-term anti-glaucoma medication use and their impact on corneoscleral limbus, precautions can be taken to balance between the risk of glaucoma progression and limbal stem cell deficiency. All relevant publications from 2000 to 2023 were included and evidence of strong emerging potential link between topical glaucoma eyedrops and the disruption of limbal stem cell homeostasis were found. Prolong use of topical glaucoma medication with preservatives were found to have a negative effect on limbal stem cells. The frequent use of topical preservative-free prostaglandin analogues and beta-blockers, commonly prescribed for glaucoma, is associated with morphological alterations in the corneoscleral limbus. These changes appear to be mediated through an inflammatory process, leading to disruption of the corneoscleral limbal niche which eventually results in limbal stem cell deficiency. With the advancement of glaucoma surgical treatment, it is possible for glaucoma treatment to shift towards earlier surgical modality to reduce topical anti-glaucoma burden leading to limbal stem cell deficiency.