Abstract
<title>Abstract</title> <p>Background Ocular surface disease (OSD) is a common comorbidity in glaucoma patients receiving topical medications, yet data from low- and middle-income countries like Bangladesh remain limited. This study aimed to determine the prevalence of OSD and assess agreement between subjective symptoms and objective tests among glaucoma patients. Methodology: This cross-sectional study enrolled 68 glaucoma patients attending Al-Noor Eye Hospital, Dhaka, from September 2025 to March 2026. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent Schirmer test and tear break-up time (TBUT) evaluation. Results Although 69.1% of patients reported normal OSDI scores, objective tests revealed significantly higher abnormality rates: 54.4% had abnormal Schirmer test results and 76.5% had abnormal TBUT. Poor agreement existed between OSDI and Schirmer test (κ=-0.193, p = 0.033), with no agreement between OSDI and TBUT (κ=-0.077, p = 0.247). Age was significantly associated with abnormal objective findings (p = 0.017–0.026), while prostaglandin analogues and carbonic anhydrase inhibitors showed unexpected protective associations. Conclusion Objective ocular surface abnormalities are highly prevalent among Bangladeshi glaucoma patients despite minimal subjective symptoms. Routine objective testing is essential for accurate OSD detection in this population.</p>