In the absence of a cure for glaucoma, eye drops and pills are used to control its progress. All glaucoma medications do either one of two things:

  • decrease the flow or production of aqueous humour (the fluid in the eye), or
  • increase the outflow or drainage of aqueous humour

Drugs that decrease the production of aqueous humour

One of the most commonly used class of eye drops is the beta-blockers. The nonselective beta-blockers include timolol (Timoptic®, Timoptic XE®, and generics) and levobunolol (Betagan® and generics), and a selective beta-blocker is betaxolol (Betoptic®-s). You may experience burning or stinging, dry eyes, redness, or a feeling as if something is in your eye. Rarely, some people experience whole body side effects, such as a slowing of the heart rate, low blood pressure, and, in susceptible individuals, difficulty breathing due to spasm of the airways.

The alpha-2 agonists include apraclonidine (Iopidine®) and brimonidine (Alphagan®, Combigan®). Brimonidine may also have a slight effect on increasing the non-conventional outflow as well. They are used in a twice daily dosage, and can cause fast heart rate, low blood pressure, headache, or a tremor.

The medications in the family known as carbonic anhydrase inhibitors are available as pills or eye drops. The eye drops include dorzolamide (Trusopt®) and brinzolamide (Azopt®). The pills include acetazolamide (Diamox®) and methazolamide (Neptazane®). The eye drops can cause occasional stinging or burning and a sour or bitter taste in the mouth. The pills may cause a "pins and needles" sensation in the fingers and toes, fatigue, depression, kidney stones, decreased appetite, and very rarely, blood disorders.

Drugs that increase the drainage of aqueous humour

The miotics include pilocarpine (Isopto-Carpine®) and carbachol (Isopto-Carbachol®). They can cause constriction (narrowing) of the pupil, which can lead to dimming of the vision. When you first start to use them you may experience an aching in the brow area. This is common and goes away after a few days of use.

The prostaglandin drugs include latanoprost (Xalatan®, Xalacom®), travoprost (Travatan Z®, DuoTrav®), and bimatoprost (Lumigan®, Lumigan RC®). These drops are generally used once daily. They can cause burning, a feeling like there is something in your eye, stinging, itching, a darkening of the iris, or increase eyelash length.

 
Frederick S. Mikelberg, MD 
in association with the MediResource Clinical Team