Primary open-angle glaucoma: management
The majority of patients with primary open-angle glaucoma are managed with eye drops. These aim to lower intra-ocular pressure which in turn has been shown to prevent progressive loss of visual field.
Surgery in the form of a trabeculectomy may be considered in refractory cases.
| Medication | Mode of action | Notes |
|---|---|---|
| Prostaglandin analogues (e.g. Latanoprost) | Increases uveoscleral outflow | Once daily administration Adverse effects include brown pigmentation of the iris |
| Beta-blockers (e.g. Timolol) | Reduces aqueous production | Should be avoided in asthmatics and patients with heart block |
| Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist) | Reduces aqueous production and increases outflow | Avoid if taking MAOI or tricyclic antidepressants Adverse effects include hyperaemia |
| Carbonic anhydrase inhibitors (e.g. Dorzolamide) | Reduces aqueous production | Systemic absorption may cause sulphonamide-like reactions |
| Miotics (e.g. pilocarpine, a muscarinic receptor agonist) | Increases uveoscleral outflow | Adverse effects included a constricted pupil, headache and blurred vision |
Surgery in the form of a trabeculectomy may be considered in refractory cases.