Meds mgt

Eye drops to improve drainage

 Prostaglandin analogs

Prostaglandin analogues are the front-line medications for the treatment of glaucoma, a condition
resulting in blindness due to the death of retinal ganglion cells. These drugs act by lowering intraocular
pressure (IOP), a major risk factor for glaucoma. Two of these drugs, latanoprost and unoprostone, are
presently commercially available.

Side and adverse effects includes changes in eyelash number/color/length/thickness, eyelid

changes/skin darkening, dry eye, lid crusting/discomfort, or increased sensitivity to light may occur.

 Beta blockers

Beta blockers such as timolol are the second most often used class of medication and work by
decreasing production of fluid. They are available in generic form and, therefore, may be less expensive.

Timolol

Timolol is a beta-blocker that also reduces pressure inside the eye. Timolol ophthalmic (for the eyes) is
used to treat open-angle glaucoma and other causes of high pressure inside the eye. Side effects include
Temporary blurred vision, temporary burning/stinging/itching/redness of the eye, watery eyes, dry eyes,
feeling as if something is in the eye, or headache may occur. If any of these effects persist or worsen,
notify your doctor or pharmacist promptly.

Carbonic anhydrase inhibitors

Cholinergic agonists

Healthline Editorial team (2020). Tonometry. Retrieved, 04/02/21 from

https://www.healthline.com/health/tonometry

MedlinePlus (2020). Opthalmoscopy. Retrieved, 04/02/21 from

https://medlineplus.gov/ency/article/003881.htm#:~:text=Direct%20ophthalmoscopy

Healthwise Staff (2019). Perimetry Test (Visual Field Testing) for Glaucoma. Retrieved, 04/02/21 from
https://www.healthlinkbc.ca/medical-tests

Bollinger, K. (2016). Gonioscopy: What Is It And Why Is It Needed? Retrieved, 04/02/21 from
https://www.glaucoma.org/treatment/gonioscopy-what-is-it-and-why-is-it-needed.

Schwab, A. (2020). What is pachymetry? Retrieved, 04/02/21 from

https://www.sharecare.com/health/glaucoma-diagnosis/what-is-
 pachymetry#:~:text=The%20doctor%20uses%20an%20ultrasonic,and%20numbing%20drops%2
0are%20unnecessary.&text=The%20process%20of%20pachymetry%20is%20painless%20and%2
0easy.

Rxlist (2018). XALATAN. Retrieved, 04/02/21 from https://www.rxlist.com/xalatan-drug.htm#description

Drugbank (2020). Unoprostone. Retrieved, 04/02/21 from https://go.drugbank.com/drugs/DB06826

Rxlist (2018). TIMOLOL. Retrieved, 04/02/21 from

https://www.rxlist.com/consumer_timolol_timol/drugs-condition.htm

Radhakrishnan, S. (2016). Glaucoma Medications and their Side Effects. Retrieved, 04/02/21 from

https://www.glaucoma.org/gleams/glaucoma-medications-and-their-side-effects.php

Drugbank (2021). Pilocarpine. Retrieved, 04/02/21 from https://go.drugbank.com/drugs/DB01085

Puma, E. (2019). Glaucoma. Retrieved, 04/02/21 from

https://www.clinicbarcelona.org/en/assistance/diseases/glaucoma/evolution-of-the-disease

Carbonic anhydrase inhibitors (CAIs) reduce eye pressure by decreasing the production of intraocular
fluid. These are available as eye drops and as pills. The pill form is an alternative for people whose
glaucoma is not controlled by medication eye drops.

Eye drops

Trusopt (dorzolamide)

Azopt (brinzolamide)

As well as pills
Diamox (acetazolamide) Acetazolamide works by blocking the action of an enzyme called carbonic
anhydrase. Blocking this enzyme reduces the amount of fluid (called aqueous humour) that you make in
the front part of your eye, and this helps to lower the pressure within your eye

Neptazane (methazolamide)].

This is an ophthalmic solution that is used for treating glaucoma. It is in a class of drugs called carbonic
anhydrase inhibitors. Many parts of the body, including the eye, contain the enzyme carbonic
anhydrase. Carbonic anhydrase controls secretion of fluid within the eye and thereby determines the
pressure within the eye, the greater the amount of fluid that is secreted, the higher the pressure.

This medication is used to treat high pressure inside the eye due to certain types of glaucoma. Lowering
high pressure inside the eye helps to prevent blindness, vision loss, and nerve damage. Methazolamide
belongs to a class of drugs known as carbonic anhydrase inhibitors.

Brinzolamide is used to treat high pressure inside the eye due to glaucoma or other eye diseases.
Lowering high pressure inside the eye helps to prevent blindness. This medication works by decreasing
the amount of fluid within the eye. It belongs to a class of drugs known as carbonic anhydrase inhibitors.
This drug have the same characteristics of dorzolamide since they both is from the drug class, carbonic
anhydrase inhibitors.

CHOLINERGIC AGONISTS

Cholinergic drugs constrict the pupillary sphincter, tighten the iris, decrease the volume of iris tissue in
the angle, and pull the peripheral iris away from the trabecular meshwork. These changes reduce
intraocular pressure (IOP) by allowing aqueous humor to reach the outflow channels.

Pilocarpine (Pilocar, Isopto Carpine) - Pilocarpine is a cholinergic parasympathomimetic agent. It

increase secretion by the exocrine glands, and produces contraction of the iris sphincter muscle and
ciliary muscle (when given topically to the eyes) by mainly stimulating muscarinic receptors.

Drugbank (2021). Pilocarpine. Retrieved, 04/02/21 from https://go.drugbank.com/drugs/DB01085

Carbachol is a parasympathomimetic that mimics the effect of acetylcholine on both the muscarinic and
nicotinic receptors. This drug is administered ocularly to induce miosis to reduce intraocular pressure in
the treatment of glaucoma.

Miostat, Carboptic, Isopto Carbachol, Carbastat

 The prognosis for glaucoma depends on the stage at which it is detected. If it is diagnosed
before it damages the optic nerve, the prognosis is generally very good, so long as the patient follows
the treatment correctly.

When the optic nerve has already suffered permanent damage and the diagnosis comes late on
(when the nerve is heavily damaged and the visual field severely affected), it requires more aggressive
treatment and implies a worse long-term prognosis.

Acute complications

The most frequent type of glaucoma, primary open-angle glaucoma, is a chronic and progressive
disease that courses with practically no symptoms; therefore, this common form does not produce any
acute complications directly related to the condition.

In the case of angle-closure glaucoma, the eye’s filter can close suddenly, provoking an abrupt
increase in intraocular pressure causing blurred vision, red eye and pain in the affected eye
accompanied by nausea and vomiting.

Chronic complications

Patients with glaucoma have reduced peripheral vision which makes it harder to carry out certain
everyday activities such as walking down stairs or driving. Patients are more likely to suffer falls and be
involved in traffic accidents. Most chronic complications, such as dry eyes, are related to the continual
use of eye drop treatments.

Puma, E. (2019). Glaucoma. Retrieved, 04/02/21 from

https://www.clinicbarcelona.org/en/assistance/diseases/glaucoma/evolution-of-the-disease