Glaucoma - Medications

Medications

Medications to lower the pressure inside the eye (intraocular pressure, or IOP) are used to treat all types of glaucoma. They work either by reducing the amount of fluid (aqueous humor) that is produced by the eye or by increasing the amount of fluid that drains out of the eye. These medications may be given as eyedrops; as pills; in liquid form by mouth; or, in emergency situations, through a vein. In most cases, eyedrops are used first.

In a sudden (acute) attack of closed-angle glaucoma, medications may be used to lower the pressure in the eye. Medications that close (constrict) the pupil may be used to open the drainage angle. If medications lower the eye pressure after an episode of acute closed-angle glaucoma, laser treatment is usually done soon afterwards to prevent such an episode from occurring again. If the medications do not lower the pressure in the eye, laser treatment will need to be done immediately.

In congenital glaucoma, medications may be used to reduce the pressure in the eyes and decrease the cloudiness of the clear front surface (cornea) of the eye. Medications usually do not work over a long period of time and are usually used only until surgery can be done.

In the media, much has been said about the possibility of using marijuana to treat glaucoma. Inhaled marijuana smoke has been shown to result in an average 25% reduction in intraocular pressure (IOP), but the effect lasts only for about 3 to 4 hours. Also, not all people who use marijuana have this reduction in IOP; it only occurs in about 60% to 65% of users. The smoke also has toxic effects on other parts of the body, particularly the lungs, and substances in the smoke cause changes in mental state. The amount of marijuana a person needs to smoke to keep eye pressure down would cause significant side effects. Because of these toxic and psychoactive effects, along with the short duration of the beneficial effect of lowering pressure in the eye, marijuana is considered a poor treatment option and is not recommended for glaucoma.¹⁰

Medication Choices

Medications used to treat glaucoma lower the pressure in the eyes (intraocular pressure, or IOP) by either decreasing the amount of fluid produced by the eyes or increasing the amount of fluid that drains out of the eyes.

Medications that decrease the amount of fluid produced by the eye include:

• Beta-blockers (such as Betagan, Betimol, Betoptic, Ocupress, OptiPranolol, and Timoptic).
• Adrenergic agonists (such as Alphagan, Epifrin, Iopidine, and Propine).
• Carbonic anhydrase inhibitors (such as Azopt, Cosopt, Diamox, Neptazane, and Trusopt).
• Hyperosmotics (such as Osmitrol, Osmoglyn, and Ureaphil).

Medications that increase the amount of fluid that drains out of the eye include:

• Cholinergics (such as Carboptic, Isopto Carpine, Phospholine Iodide, Pilocar, Pilopine HS, and Pilostat).
• Adrenergic agonists (such as Alphagan, Epifrin, Iopidine, and Propine).
• Prostaglandin analogs (such as Lumigan, Travatan, and Xalatan).

What To Think About

When medications are used to treat glaucoma, the goal is to prevent further damage to the optic nerve by lowering the pressure in the eyes. The level of pressure in the eye needed to damage the optic nerve varies from one person to another. For this reason, a single target eye pressure cannot be used for everyone. Your target pressure may need to be adjusted if the optic nerve shows further damage despite treatment.

When glaucoma has already caused vision loss, further vision loss may develop even after the pressure in the eye is lowered to the normal range with medication.

In most cases, medications used to treat glaucoma must be continued daily for the rest of your life. Putting eyedrops in the eye at specific times of the day may be inconvenient. Eyedrops may also cause discomfort. You need to follow the prescribed daily schedule for your eyedrops in order for them to work properly.

• Discuss the goals of treatment, how long the medication will be tried, and the possible side effects with your health professional. Eye medications can cause symptoms throughout the body. Report side effects to your eye doctor.
• Knowing how to correctly insert your eyedrops can make the medication work better and may help you avoid side effects. A medication card stating which medications need to be taken at different times of the day can be helpful in reminding you to take medications. Use multicolored bottle caps to help you tell different medications apart.
• You will need follow-up visits with your health professional shortly after starting a new medication to determine whether it is working as well as it should be and to discuss any side effects or medication schedule problems.

Medications for glaucoma can be expensive. Some cost-saving tips such as using a measured-dose dispenser may help.

Let all your health professionals know that you are taking glaucoma medications. Other medications that you are taking may need to be adjusted or stopped to prevent side effects.

While there are fewer complications from the new surgical procedures for glaucoma, medication treatment still usually has fewer side effects than surgery. Many people who use glaucoma medications may never need surgery for glaucoma.