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The Medical Treatment of Glaucoma

Glaucoma is normally medically controlled using eye-drops. In acute cases Acetazolamide tablets or injections are used usually when the intra-ocular pressure is very high, often prior to Glaucoma Surgery.

Some types reduce the fluid entering the eyes and others help it escape more easily. Some act in both ways.

The two most common families of glaucoma medication currently used are Prostaglandin Analogues and Beta Blockers

Prostaglandin/prostamide analogues. This type of drop includes Latanaprost (Xalatan), Lumigan(Bimataprost) and Travatan (Travaprost). These drops improve the flow of fluid out of the eye through the non-conventional (uveo-scleral) outflow pathway and are used once a day, usually at night. Possible side effects include a pink slightly inflammed eye that usually improves after a few days or weeks. The iris may darken in colour and the eyelashes may grow thicker and darker. Eye colour change is most common with green or hazel eyes, which become browner, and is least common with blue eyes.

Beta Blocking eye drops work by blocking the stimulating signals that normally instruct the fluid producing cells in the ciliary body to secrete aqueous humour. Examples of beta-blocking glaucoma eye drops include Timolol and Betaxalol. The main effect on the eye with beta-blocking drops such as Timolol (eg Timoptol) , which is very satisfactory, but occasionally in patients with asthma, difficult breathing, or certain types of heart trouble, timolol drops may aggravate the condition so that such patients may not be suitable for this type of treatment.

Carbonic anhydrase inhibitors block an enzyme called carbonic anhydrase which is involved in the production of aqueous humour in the ciliary body. Examples of carbonic anhydrase inhibitors include the eye drops Dorsolamide (Trusopt) and Brinzolamide (Azopt) and the tablet form, Azetazolamide (Diamox). The tablets of acetazolamide (Diamox) or dichlorphenamide (Daranide, Oratrol) directly affect the eye by reducing fluid going into it. They may be undesirable in patients with kidney trouble. Eye drop carbonic anhydrase inhibitors have less effects on the body. They do have a bitter taste and can sting on instillation.

 

Alpha agonists. This type of drop includes Brimonidine (Alphagan) and Iopidine. These drops reduce the production of fluid in the eye and possibly improve the flow of fluid out of the eye a little. They are used two or three times a day. Possible side effects include a dry mouth and a feeling of being generally unwell. Alphagan may cause nightmares in children and should not be used in infants. Allergies are relatively common with Brimonidine.

Cholinergic agonists. This type of drop includes Pilocarpine. This drop improves the flow of fluid out of the eye through the conventional outflow pathway and has to be used three or four times a day. A gel preparation, Pilogel, can be used once at night. The drop makes the pupil small and possible side effects include headache or eye ache (this usually wears off), blurred vision and darkening of the vision.

Cholinergic agonists. This type of drop includes Pilocarpine. This drop improves the flow of fluid out of the eye through the conventional outflow pathway and has to be used three or four times a day. A gel preparation, Pilogel, can be used once at night. The drop makes the pupil small and possible side effects include headache or eye ache (this usually wears off), blurred vision and darkening of the vision.

Surgery For Glaucoma

For some people, surgery might be the best treatment for glaucoma. Your ophthalmologist may suggest surgery as a first treatment, or after trying medication to lower your IOP.

 

 

 

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