Glaucoma Drops explanation

Sandra Lora Cremers, MD, FACS

GLAUCOMA MEDICATIONS: Apply Punctal Occlusion after drop placed to improve drug efficacy.

Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. These eye drops are intended to reduce elevated intraocular pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye which then helps prevent damage to the optic nerve. [Decrease systemic side effects of drops by closing eye after drop placed & applying slight pressure with finger on the outside of lid near nose to occlude the puncta; this prevents the drug from entering the tear drainage duct & systemic circulation.]Tell your MD if you have any negative side effects of your drops.

I. Alpha Agonist
Alpha agonists work to both decrease production of fluid and increase drainage. Alphagan P has a purite preservative that breaks down into natural tear components and may be more effective for people who have allergic reactions to preservatives in other eye drops. Alphagan is available in a generic form. Side Effects: Side effects can include burning or stinging upon instillation of the eye drop, fatigue, headache, drowsiness, dry mouth and dry nose.

Beta blockers decrease intraocular fluid production. Side Effects: can include low blood pressure, reduced pulse rate, fatigue. Shortness of breath possible in people who have a history of asthma or other respiratory disorders. They can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart’s response rate during exercise. Rare side effects include reduced libido and depression.

III. Carbonic Anhydrase Inhibitors:
Carbonic anhydrase inhibitors (CAIs)  decrease production of intraocular fluid. If you are using more than one type of eyedrop, wait 5 minutes between eyedrop medicines. The pill form is an alternative for people whose glaucoma is not controlled by medication eye drops. Side Effects: (of pill) tingling or loss of strength of the hands and feet, upset stomach, mental fuzziness, memory problems, depression, kidney stones, and frequent urination; (of eye drop) stinging, burning and other eye discomfort.

IV. Cholinergic (Miotic)
By making the pupil size smaller, cholinergics increase the drainage of intraocular fluid through the trabecular meshwork. They can be used alone or combined with other medications. Side Effects: dim vision, especially at night or in darkened areas such as movie theaters (due to constriction of the pupil.)

V. COMBINED MEDICATIONS: Decreases production of intraocular fluid.
Combined medications can offer an alternative for patients who need more than one type of medication. They can be more convenience and may also be a financial advantage, depending on your insurance plan. Combigan is a combination of beta blocker and alpha agonist. Cosopt is a combination of beta blocker and carbonic anhydrase inhibitor. Side Effects: of Combigan include the symptoms of beta blockers and alpha agonists. Side effects of Cosopt include burning and/or stinging of the eyes and changes in sense of taste. Since these medications are new to the market, long term follow up of people using these medications is not yet available.

VI. Prostaglandin Analogs: are medications that work like prostaglandins in your body.
Prostaglandin analogs increase the outflow of intraocular fluid from the eye. They have few systemic side effects but can change the eye itself, including change in iris color and growth of eyelashes. Depending on the individual, one brand of this type of medication may be more effective and produce fewer side effects. They are effective at reducing intraocular pressure in people who have open-angle glaucoma. Side Effects: Between 5% and 15% of people reported a gradual change in eye color, due to an increased amount of brown pigment in the iris of the treated eye. The change in eye color occurs slowly and may not be noticeable for several months/years. TELL YOUR MD if you would be unhappy with a change (other drops, though, have other sometimes more significant side effects or may not work as well for you). Other side effects can include stinging, blurred vision, eye redness, itching, & burning.

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