For those who have recently been diagnosed by an eye doctor as having glaucoma, the good news is that although glaucoma cannot be reversed, once the intraocular fluid has been reduced, pressure on the optic nerve will be lowered and further loss in vision can be prevented. For most people, eye drops are prescribed to reduce the pressure caused by the fluid inside the eye, which is the cause of the glaucoma.
Eye drops are generally the first choice of treatment by doctors and over 80% of patients are successfully treated with eye drops. Other possible treatments are outlined in a further article on Glaucoma Treatment. Eye drops work by reducing the production of the aqueous humor inside the eye, or by increasing the flow of the fluid and helping it to drain away efficiently. Both these goals bring about the same result - a lowering of pressure in the eye caused by the build up of fluid. It is surprising that such a serious disease as glaucoma can be caused by such a simple malfunction.
For patients who are deemed to be suitable patients for glaucoma eye drops, more than one type of eye drops may be prescribed. The efficacy of many of the eye drops is actually enhanced by other eye drops as they all work together. Some glaucoma sufferers may not be suitable for eye drops if the medications are absorbed into the membrane that lines the eyelid and the eye, rather than treating the drainage of the aqueous humor. Some patients with other medical conditions may not be suitable candidates for eye drops as a small amount will inevitably be absorbed into the blood stream and may interact with other medications.
Applying eye drops regularly and correctly will maximize their effectiveness. See 'Best Practices for the Application of Eyedrops' in the Glaucoma Treatment article for more information.
Types of glaucoma eyedrops are many and varied, but they all fall into one of the following categories, depending upon the active ingredient of the treatment.
These eye drops relax the muscles in the eye to allow a better drainage of the intraocular fluids. They are applied once a day. Generally intraocular pressure is reduced by about 30% with these drugs. Side effects may include slight burning or stinging in the eye, darkening of the iris or eyelids and curling or lengthening of the eyelashes - not all bad! Prostaglandins are now the primary therapy for treating glaucoma and brand names include Xalatan, Lumigan, Travatan Z and Rescula.
Beta blockers work by decreasing the fluid made within the eye. They are often prescribed as well as prostaglandins to effectively make less fluid in the eye and improve drainage of what fluid is produced, thereby reducing intraocular pressure. Beta-blockers are not suitable for patients with certain other medical conditions, so let your eye doctor know your full medical history when deciding upon your glaucoma treatment. Side effects may include difficulty breathing, mood changes, impotence and cardiovascular changes. Best known examples are Timoptic XE, Istalol and Betoptic S.
This tongue-twistingly named drug also decreases the production of aqueous humor in the eye. Common side effects may include bloodshot eyes, upper eyelid elevation, dilated pupils and an itchy sensation. Iopidine, Alphagan and Alphagan P are commonly prescribed.
Carbonic Anhydrase Inhibitors
Carbonic Anhydrase Inhibitors have been in use for over 50 years and are available as eye drops or pills. They work by reducing the rate at which fluid is made in the eye. They are generally prescribed along with other glaucoma eye drop treatments. Eye redness, burning, a bitter taste and eyelid reactions are some of the side effects these drugs may evoke. Commonly prescribed Carbonic Anhydrase Inhibitors include Trusopt and Azopt in eye drops and Diamox, Neptazane and Daranide in pill form. The pills may cause a loss of appetite and weight loss, tingling in the fingers and toes, fatigue, depression, kidney stones or a loss of libido.
These eye drops increase the drainage and outflow of the fluid from the inner eye and are particularly effective for those with narrow-angle glaucoma. By causing the pupil to constrict, the drainage angle should be opened to allow drainage of the aqueous humor. The side effects include reduced night vision, burning, and an ache above the eye. Brands include Pilocarpine, Carbachol, Demecarium and Echothiophate.
These drugs have a dual effect upon the eye, reducing the production of fluid and increasing the drainage outflow. Blocked tear ducts, allergy, heart palpitations and pigmented eye surface membrane deposits may all be experienced. Allergan's Propine and Epiniphrine are the most commonly prescribed drug names.
These drugs are used for those who need an urgent reduction in their intraocular pressure. They are often prescribed as an emergency one-time treatment by injection to reduce the aqueous fluid rapidly. Mannitol and Urea are given intravenously and Glycerin and Isosorbide are given orally.
To avoid glaucoma sufferers having to apply several different eye drops, combination eye drops are being developed. Examples now available include Cosopt, Combigan and DuoTrav.
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