Common glaucoma medications

Glaucoma medications, which are usually administered as eye drops or orally in pill form, are used to manage the fluid pressure inside the eye (also called intraocular pressure, or IOP). Successfully maintaining normal eye pressure over a person’s lifetime is essential to limit vision loss from glaucoma.

The number of treatment options for glaucoma can feel overwhelming at first. Each class of glaucoma medication acts in a slightly different way, and some may work better for one person than another.

As with many other medicine, glaucoma medications can also have different side effects for different people. The key to finding a successful glaucoma treatment plan is by working with your eye doctor to find a medication (or combination of medications) that provides the best results with the most manageable side effects.

Thankfully, ophthalmologists and optometrists are thoroughly trained to help you explore every option and guide you down a customized treatment path.

QUESTIONS ABOUT GLAUCOMA TREATMENT OPTIONS? Find an eye doctor near you and make an appointment.

Eye drops for glaucoma

Prescription eye drops are the most common glaucoma medication prescribed by eye doctors to normalize eye pressure.

Glaucoma eye drops are classified by the active ingredient that makes each drug work. Most of the options listed below are available in both brand-name and generic and forms through your local pharmacy.

Prostaglandins

Prostaglandin eye drops — also called prostaglandin analogs — reduce eye pressure by increasing the outflow of fluid from the eye.

Popular brands of prostaglandin glaucoma medications include: Lumigan (bimatoprost); Travatan Z (travoprost); Xalatan (latanoprost); Vyzulta (latanoprostene bunod); and Zioptan (tafluprost). These drops only need to be used once per day, making it easier for patients to remember to use them regularly.

Side effects from prostaglandin glaucoma eye drops are relatively rare. Their use can increase the growth of eyelashes and may change the color of the iris.

Beta blockers

Beta blocker glaucoma eye drops help reduce eye pressure by decreasing the production of aqueous fluid in the eyes. They’re commonly prescribed alongside prostaglandin drops, when necessary. Brand names (and generic names) of beta blocker drops include Timoptic (timolol) and Betoptic (betaxolol).

Beta blocker glaucoma medications can have a number of eye and systemic side effects, including blurred vision, burning or stinging in the eyes, chest pain or discomfort, depression, headache, irregular heartbeat, fatigue, muscle and joint pain, and more. (Your eye doctor can explain how to reduce the risk of systemic side effects of glaucoma medications.)

Alpha-adrenergic agonists

Alpha-adrenergic glaucoma medications reduce eye pressure by both decreasing the rate of production of aqueous fluid in the eye and increasing its drainage from the eye. Examples include Alphagan P (brimonidine) and Iopidine (apraclonidine).

Side effects of alpha-adrenergic drops can include red or itchy eyes and eyelids, swollen eyelids, dry eyes, dry mouth, drowsiness, headache, dizziness, a bad taste in the mouth, and more.

Carbonic anhydrase inhibitors (CAIs)

These glaucoma eye drops reduce eye pressure by decreasing the production of aqueous fluid in the eye. Examples include Trusopt (dorzolamide) and Azopt (brinzolamide). They’re usually used in combination with other eye drops used to treat glaucoma.

CAIs are also available in pill form. Examples include Diamox (acetazolamide) and Neptazane (methazolamide).

Side effects of CAI glaucoma eye drops include: blurred vision; red, itchy or burning eyes; watery eyes, dry eyes, headache and a bitter taste in the mouth. Side effects of oral CAI glaucoma medications can include tingling or numbness in the fingers or toes, dizziness, loss of appetite, headache, fatigue, irritability and more.

Rho kinase inhibitors

This is a new class of glaucoma eye drops that reduces eye pressure by increasing the drainage of aqueous fluid from the eye. Rhopressa (netarsudil) is a rho kinase inhibitor that has been available since April 2018.

Side effects of Rhopressa include red eyes, opacities in the cornea, eye burning or stinging, blurred vision, and watery eyes.

Combination glaucoma eye drops

Many glaucoma patients require more than one type of medication to normalize their eye pressure. Pharmaceutical companies have produced certain “combination” eye drops that include two different glaucoma medications in the same bottle.

Combination eye drops are convenient because they may reduce the number of glaucoma eye drop medications you need to use every day.

Examples of combination glaucoma eye drop medications include:

• Cosopt is a combination of a beta blocker (timolol) and a carbonic anhydrase inhibitor (dorzolamide). It is also available in a preservative-free formulation (Cosopt PF).

• Combigan is a combination of an alpha-adrenergic agonist (brimonidine) with a beta blocker (timolol).

• Simbrinza is a combination medication consisting of a CAI (brinzolamide) and an alpha-adrenergic agonist (brimonidine).

• Rocklatan is a relatively new combination glaucoma medication that combines latanoprost (the most widely-prescribed prostaglandin analog) and netarsudil (the active ingredient in Rhopressa). Rocklatan reduces eye pressure by increasing the outflow of aqueous humor from the eye and is prescribed for once-a-day use.

Potential side effects of combination eye drops are similar to those of the separate medications contained in the drop.

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Emergency glaucoma medications

Some medications are geared toward a painful type of glaucoma that occurs over a short period of time called narrow-angle or acute angle-closure glaucoma. This can also occur after a traumatic eye injury.

Glaucoma that comes on suddenly requires immediate treatment to avoid vision loss. When surgery can be avoided, an eye doctor could use one of the following medications:

Parasympathomimetics

These drugs work by increasing how much aqueous humor fluid flows out of the eye, especially in the case of narrow-angle glaucoma. Parasympathomimetic eye drops cause the pupil to get smaller, which helps open up the narrowed or blocked drainage area in the eye.

Hyperosmotic agents

Hyperosmotic agents reduce eye pressure by reducing the amount of fluid inside the eye. These drugs are usually reserved for severely high eye pressure that requires immediate treatment to avoid optic nerve damage. 

There are oral and intravenous hyperosmotic drugs, which are usually only administered on a one-time, emergency basis.

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New glaucoma treatments and continuing research

The medical and pharmaceutical industries are always searching for new ways to improve upon the current treatments of glaucoma.

In addition to new glaucoma eye drops and medications, there are a number of types of glaucoma surgery that are currently available and others in development.

Soon there even may be electronic glaucoma glasses developed that can reduce eye pressure to help control glaucoma without the risk of medicinal side effects or surgery.

RECENTLY DIAGNOSED WITH GLAUCOMA? Find an eye doctor near you and schedule an appointment to discuss medication and treatment options.

Page published on Friday, June 19, 2020