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Medical management for Glaucoma

Glaucoma Eye Drops

Iotim, Travacom, Gaucoma eye drops

Introduction

Some of the commonly used glaucoma eye drops like iotim and travacom are very well known. But the range of medicines available today is wider than that. With scientific advances, now there are a variety of medicines which have a multi pronged approach to reducing eye pressure. These medicines along with the common iotim and travacom help treat the most difficult cases of glaucoma.

Categories of glaucoma eye drops

Beta blocker

What it does: These glaucoma eye drops act on the beta adrenergic receptors in the eye. These receptors are present in the ciliary body which manufactures aqueous humour(the fluid inside the eye). These medicines block the receptors which stops the ciliary body from making any fluid. The reduction in fluid in the eye helps bring the intraocular pressure down.

Common trade names:
Iotim, Glucomol. These drops contain timolol as the main ingredient.
Bexol, Iobit. These drops contain betaxolol.

These drops are not advisable for:
Pregnant women
Patients with asthma
Patients with heart problems.

In asthmatics and heart patients betaxolol is safer as it only acts on one type of beta receptor unlike timolol that acts on all beta receptors.

Dosage: these drops should get instilled 2 times in the day. One drop in the morning and one drop in the evening.

II. Prostaglandin analogues

What it does: this category of glaucoma eye drops increases the outflow of fluid from the eye. It does this by relaxing the muscle fibres in the eye so the drainage channels open up. Once the channels open the fluid drains out easily.

Common trade names:
Xalatan, Lacoma, Ioprost. These are the trade names of latanoprost
Lumigan , Bimat. These are the trade names of bimatoprost
Travatan, Tovaxo, Lupitros. These are the trade names of travoprost.

These drops are not advised for:
People who have allergy to prostaglandins
People who have inflammation in and around the eye
If eye has undergone some surgery recently

Dosage : these drops have to be out once at night.

III. Carbonic anhydrase inhibitors

What it does: these glacuoma eye drops inhibit the enzyme carbonic anhydrase in the ciliary body. This enzyme is required for the formation of fluid in the eye. When the enzyme is inhibited fluid is not formed and eye pressure comes down.

Common trade names:
Dortas, Dorzox. These are trade names for dorzolamide.
Brinzox, Azopt. These are trade names for brinzolamide.
Diamox. Oral medication which contains acetazolamide.

These drops are not advised for:
Pregnant women
People with sulpha drug allergy
Patients of severe kidney disease.

Dosage : the drops should get instilled 2-3 times a day depending on the severity of glaucoma.Used in combination usually along with a beta blocker or prostaglandin analogue. Alone it does not cause a lot of pressure reduction.
Diamox which is the oral tablet in this category given if pressure is very high (>40 mm of hg). Advised only for a short term as it can cause problems in the body. Its advised in patients awaiting surgery. Its dosage is 3 tablets per day.

IV. Alpha 2 receptor agonists

What it does: These glaucoma eye drops act on the alpha 2 adrenergic receptors in the ciliary body of the eye. When these receptors get activated the ciliary body stops making aqueous humour. This helps reduce eye pressure. Along with reducing eye pressure these medicines also have a neuro protective effect. They protect the optic nerve from getting damaged.

Common trade names:
Bidin, Alphagan. These contain brimonidine in them.

These drops are not advised for:
Children. As these drops have an effect on the brain of children and can cause sleepiness.

This is the only medicine advised for pregnant women in the first trimester but with caution.

Dosage: these drops should get instilled 2 times in a day. One drop in the morning and one in the evening.

V. Osmotic agents

What it does: These medications are either taken orally or intravenous at the hospital. They get into the bloodstream. As they are very viscous in nature they pull fluid out of the organs through osmosis. The eye fluid gets pulled out and the pressure comes down. They are very fast acting and given in emergencies only.

Common trade names:
Known by their generic names oral glycerol and IV mannitol.

They are not advisable for:
People with heart problems
People with kidney failure

Dosage : IV mannitol administered in the hospital premise as a temporary reduction in eye pressure. Its used before glaucoma surgery.
Glycerol dose is 30 ml syrup mixed in juice or coconut water 3 times a day.
This is also a temporary drug before a permanent treatment like surgery advised.

VI. Miotic agents

What it does: These glacuoma eye drops acts on the muscles of the iris and constricts the pupil. This in turn opens up the drainage angle in the periphery of the eye. It is helpful in angle closure glaucoma.

Common trade names:
Pilocar. This drug contains pilocarpine.

They are not advisable for:
Pregnant women.
People with recent eye surgery
People with retinal detachment

Dosage: pilocarpine instilled 4 times a day. It has different strengths 1%, 2%, 3% and 4%. Depending on the severity of the disease the strength is decided. Although pilocarpine was effective earlier it is rarely used now. Its only use these days is temporarily before YAG PI or laser iridotomy.

Fixed drug combinations(FDC)

Many times glaucoma is not managed with one drop alone. Many different categories of drops are required to bring the eye pressure down. This requires patients to put many drops at various times of the day. It is very tiring to put so many drops in a day. Many times patients forget to put a drop and this causes eye pressure to fluctuate.

To solve this problem fixed drug combination drops are available. These drops are the combination of 2 categories of drugs in one bottle.

Common FDCs:

Travacom: travoprost and timolol combination
Misopt: dorzolamide and timolol combination
Combigan: timolol and brimonidine combination
Brimopress: timolol and brimonidine combination
Simbrinza: brinzolamide and timolol combination

There are plenty more in the market.

Dosage : Most of these glaucoma eye drops combinations are to be instilled 2 times a day. In some cases 3 times,depending on the severity.

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