TABLE 3.

Human studies reporting ocular surface disease manifestations of non-BAK preserved pressure lowering medications.*^†

Drug class	Findings	Polyquad	Sofzia	Purite	References
PGAs	Periocular changes	Skin pigmentation	Skin pigmentation	-	Kammer et al. (2010); Mizoue et al. (2014); Lopes et al. (2015); Peace et al. (2015); El Hajj Moussa et al. (2018); Ortiz-Basso et al. (2018); Muz et al. (2021)
			DUES
	LD system	↓Schirmer	Not reported	-
		↓tear film stability
	Meibomian glands	MG dropout	MG dropout	-
		↓tear film stability	↓tear film stability
	Conjunctiva	Hyperemia	Hyperemia	-
		Edema
	Cornea	Punctate keratitis	Punctate keratitis	-
		↓Corneal hysteresis
Beta blockers	Periocular changes	Not reported‡	-	-	Schnober et al. (2015)
	LD system	Not reported‡	-	-
	Meibomian glands	Not reported‡	-	-
	Conjunctiva	Hyperemia‡	-	-
	Cornea	Punctate keratitis‡	-	-
Alpha agonists	Periocular changes	-	-	Eyelid edema	Whitson et al. (2006); Duru and Ozsaygili. (2020)
				Periocular CD
	LD system	-	-	↓Schirmer
	Meibomian glands	-	-	Not reported
	Conjunctiva	Hyperemia	-	Hyperemia
		Allergic conjunctivitis		Allergic conjunctivitis
				↓Goblet cell density
	Cornea	-	-	Punctate keratitis
				PSK

*Blank cells indicate that there are no available formulations containing of the drug class and the preservative.

^†There are no available formulations of Polyquad-, Sofzia, and Purite-preserved carbonic anhydrase inhibitors, miotics, rho kinase inhibitors, and nitric-oxide donating PGAs.

^‡Polyquad-preserved beta blockers only exist in fixed combinations with prostaglandin analogs (travoprost).

BAK, benzalkonium chloride; PGAs, prostaglandin analogs; DUES, deepening upper eyelid sulcus; LD, lacrimal drainage; MG, Meibomian gland; CD, contact dermatitis; PSK, pseudo-dendritic keratitis.