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Glaucoma eye drops

More about Glaucoma

INTRODUCTION

Glaucoma eye drops fall under medical management of glaucoma. Some commonly used glaucoma eye drops like Iotim and Travacom are well known. But the range of medicines available today is more comprehensive than that. With scientific advances, there are a variety of medications with a multi-pronged approach to reducing eye pressure. These medicines, along with the common Iotim and Travacom, help treat the most complex 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 ciliary body's receptors 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.

Betaxolol is safer in asthmatics and heart patients as it only acts on one type of beta-receptor, unlike timolol that works on all beta receptors.

Dosage: these drops should get instilled two 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 quickly.

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 allergies to prostaglandins
  • People who have inflammation in and around the eye
  • If the eye has undergone some surgery recently

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

III. CARBONIC ANHYDRASE INHIBITORS

What it does: these glaucoma eye drops inhibit the enzyme- carbonic anhydrase in the ciliary body. This enzyme is required for the formation of fluid in the eye. This fluid is not formed when the enzyme is inhibited, and eye pressure decreases.

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 with severe kidney disease.

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

IV. ALPHA 2 RECEPTOR AGONISTS

What it does: These glaucoma eye drops act on the alpha two adrenergic receptors in the eye's ciliary body. When these receptors get activated, the ciliary body stops making aqueous humour, which helps reduce eye pressure. Along with lowering eye pressure, these medicines also have a neuroprotective 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. These drops affect 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 two times 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 and are 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 premises as a temporary reduction in eye pressure. It's used before glaucoma surgery.
Glycerol dose is 30 ml syrup mixed in juice or coconut water three times a day.
This is also a temporary drug before a permanent treatment like surgery is advised.

VI. MIOTIC AGENTS

What it does: These glaucoma eye drops act on the muscles of the iris and constrict the pupil, which in turn opens up the drainage angle in the eye's periphery. 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 four 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. Patients are thus required to put many drops at various times of the day. It is very tiring to put so many drops in a day. Often, patients forget to put a drop, which 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 instilled two times daily. In some cases, three times, depending on the severity.

 
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