IOP vs OSD: The Collision of Control Paradigms™
When Two Management Philosophies Compete for the Same Patient.
Course Overview
Glaucoma management and ocular surface disease management are often taught as separate disciplines — but in clinical practice, they collide. The preserved benzalkonium chloride in most glaucoma drops is toxic to the very epithelium clinicians are trying to protect. The anti-inflammatory agents used to treat dry eye can mask the pressure changes that signal glaucoma progression. This Masterclass examines the structural conflict between these two management paradigms: how the ciliary body, trabecular meshwork, and aqueous dynamics interact with the tear film, epithelium, and meibomian gland ecosystem — and what happens when the treatment of one destabilizes the other.
Clinical Relevance
The patient with both elevated IOP and significant ocular surface disease is not rare — it is the rule in an aging population. Yet most clinical training addresses these conditions in separate modules, leaving clinicians without a framework for managing the conflict. This course provides that framework: a side-by-side analysis of the Internal Pressure World and the Ocular Surface World, the points at which they intersect, and the clinical decision-making principles that allow both to be managed without sacrificing one for the other.
Course Details
Credit hours and COPE approval pending. Join the waitlist to receive notification when this course becomes available.
Learning Objectives
Upon successful completion of this educational experience, the clinician will be able to:
Describe the structural and physiological components of the Internal Pressure World (IOP control, ciliary body, trabecular meshwork, Schlemm's canal, uveoscleral outflow, optic nerve protection) and the Ocular Surface World (tear film, epithelium, meibomian glands, microbial ecosystem, immune surveillance).
Identify the mechanisms by which glaucoma medications — particularly those containing benzalkonium chloride — disrupt ocular surface homeostasis.
Explain how ocular surface disease and its treatments can complicate the accurate measurement and management of intraocular pressure.
Apply a clinical decision-making framework for patients presenting with concurrent glaucoma and ocular surface disease, including medication selection, sequencing, and monitoring priorities.
Recognize the clinical presentations in which IOP management and OSD management are in direct conflict, and articulate a defensible approach to resolving that conflict.
Course Modules
This educational experience is organized into the following modules. Content is subject to refinement prior to final release.
The Internal Pressure World
Anatomy and physiology of IOP regulation — ciliary body secretion, trabecular outflow, uveoscleral outflow, and the structural basis of optic nerve vulnerability.
The Ocular Surface World
Tear film architecture, epithelial barrier function, meibomian gland physiology, and the microbial ecosystem — the components of ocular surface homeostasis.
The Collision
Where the two paradigms intersect: BAK toxicity, preservative-induced surface disease, the effect of surface instability on tonometry, and the anti-inflammatory paradox.
Clinical Decision-Making at the Intersection
A structured approach to the patient with both conditions — medication selection, preservative-free alternatives, sequencing treatment, and monitoring for cross-system effects.
Resolving the Conflict
Case-based integration: applying the dual-paradigm framework to real clinical scenarios and building a management plan that respects both systems.
Educational Philosophy
This educational experience is designed to support clinical reasoning and evidence-informed decision-making. It does not constitute clinical advice and should not replace consultation of official prescribing information, applicable standards of care, or the clinical judgment of the treating clinician. COPE approval and credit hours are pending and will be confirmed prior to release.
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Join the waitlist for IOP vs OSD: The Collision of Control Paradigms™ and receive notification when this educational experience becomes available.
Companion Resource
The Clinician's Companion
Explore the therapeutic reference library designed to support the clinical reasoning developed in MYODCE educational experiences.
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