A variety of options are available to treat glaucoma. These include eye drops and surgery. All are intended to decrease eye pressure and, thereby, protect the optic nerve.

Currently, eye drops are often the first choice for treating patients. For many people a medications can safely control eye pressure for years.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye.

Drugs to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogs, beta blockers, alpha agonists, and carbonic anhydrase inhibitors. In addition, combination drugs are available for patients who require more than one type of medication.

Types of Glaucoma Eye Drops

Prostaglandin analogs they work by increasing the outflow of fluid from the eye. They have few systemic side effects but are associated with changes to the eye itself, including change in iris color and growth of eyelashes (see "Side Effects" below). Depending on the individual, one of these brands may be more effective and produce fewer side effects.

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, are relatively inexpensive. Moreover, systemic side effects can be minimized by closing the eyes following application or using a technique called punctal occlusion that prevents the drug from entering the tear drainage duct and systemic circulation.

Alpha agonists (Alphagan®P, iopidine®) 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.

Carbonic anhydrase inhibitors (CAIs) reduce eye pressure by decreasing the production of intraocular fluid. These are available as eye drops (Trusopt®, Azopt™) as well as pills [Diamox® (acetazolamide) and Neptazane® (methazolamide)].

Combined medications can offer an alternative for patients who need more than one type of medication. In addition to the convenience of using one eyedrop bottle instead of two, there may also be a financial advantage, depending on your insurance plan.

Treatment Concerns

Of course, no eye drop medication can be effective if it is not taken as prescribed. There are a number of reasons why people being treated for glaucoma may not take their medications.

One reason is that they simply forget! Remembering to take a daily medication is one of the challenges in the treatment of any chronic condition, and glaucoma is no exception. Some ways to help remember include tying a regular daily activity (such as brushing one’s teeth) to taking one’s medication, or setting timed reminders such as an alarm clock or cell phone.

A second factor in not taking medication as prescribed is economics. Glaucoma drugs can be expensive.

Side Effects of Glaucoma Medications

Following are potential side effects of the most commonly prescribed types of glaucoma medications.

* Prostaglandin Analogs: possible changes in eye color and eyelid skin, stinging, blurred vision, eye redness, itching, burning.

* Beta Blockers: low blood pressure, reduced pulse rate, fatigue, shortness of breath; rarely: reduced libido, depression.

* Alpha Agonists: burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction.

* Carbonic Anhydrase Inhibitors: in eye drop form: stinging, burning, eye discomfort; in pill form: tingling hands and feet, stomach upset, memory problems, depression, frequent urination.

Side effects of combined medications may include any of the side effects of the drug types they contain.