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Malignant Glaucoma Medication

  • Author: Mauricio E Pons, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: May 31, 2016

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.


Beta-adrenergic receptor blocking agents

Class Summary

The exact mechanism of ocular antihypertensive action is not established, but it appears to be a reduction of aqueous humor production.

Timolol ophthalmic (Timoptic)


First-line treatment. Precise mechanism by which timolol decreases IOP is not well established, although it is thought to be through reduction of aqueous formation.

Betaxolol ophthalmic (Betoptic-S)


Cardioselective beta1-adrenergic receptor blocking agent with minimal effect on pulmonary and cardiovascular parameters. Precise mechanism by which betaxolol decreases IOP is thought to be through reduction of aqueous formation.

Carteolol ophthalmic


Nonselective beta-adrenergic receptor blocking with intrinsic sympathomimetic activity. Precise mechanism by which carteolol decreases IOP is thought to be through reduction of aqueous formation.

Levobunolol (Betagan)


Noncardioselective beta-adrenergic receptor blocking agent. Precise mechanism by which levobunolol decreases IOP is thought to be through reduction of aqueous formation.



Nonselective beta-adrenergic receptor blocking agent. Precise mechanism by which metipranolol decreases IOP is thought to be through reduction of aqueous formation.


Alpha2-adrenergic receptor agonists

Class Summary

May decrease IOP by reducing aqueous humor production.

Apraclonidine (Iopidine)


Reduces elevated, as well as normal, IOP whether accompanied by glaucoma or not. Apraclonidine is a relatively selective alpha-adrenergic agonist that does not have significant local anesthetic activity. It has minimal cardiovascular effects. Generally used in short-term therapy.

Brimonidine (Alphagan P)


This medication lowers pressure by allowing better fluid drainage from within the eye and also by reducing the amount of fluid formed in the eye.


Oral carbonic anhydrase inhibitors

Class Summary

By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit carbonic anhydrase in the ciliary processes of the eye. This effect decreases aqueous humor secretion, reducing IOP.

Acetazolamide (Diamox)


Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP.


Topical carbonic anhydrase inhibitor

Brinzolamide (Azopt)


Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP.

Dorzolamide (Trusopt)


Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP.


Hyperosmotic agents

Class Summary

Lower IOP by creating an osmotic gradient between ocular fluids and plasma. They are not for long-term use.

Mannitol (Resectisol, Osmitrol)


Lowers IOP by increasing the osmotic gradient between blood and ocular fluids, resulting in loss of water from the vitreous.


Prostaglandins, ophthalmic

Class Summary

Prostaglandin analogs reduce intraocular pressure by increasing uveoscleral outflow. These agents typically lower IOP by 25%-30%

Latanoprost (Xalatan)


Latanoprost may decrease IOP by increasing the outflow of aqueous humor. Patients should be informed about possible cosmetic effects to the eye/eyelashes, especially if uniocular therapy is to be initiated.

Bimatoprost (Latisse, Lumigan)


This agent is a prostamide analog with ocular hypotensive activity. It mimics the IOP-lowering activity of prostamides via the prostamide pathway. Bimatoprost ophthalmic solution is used to reduce IOP in open-angle glaucoma and ocular hypertension.

Travoprost ophthalmic (Travatan Z)


This agent is a prostaglandin F2-alpha analog. It is a selective FP prostanoid receptor agonist that is believed to reduce IOP by increasing uveoscleral outflow. Travoprost ophthalmic solution is used to treat open-angle glaucoma and ocular hypertension.

Tafluprost (Zioptan)


Tafluprost is a topical, preservative-free, ophthalmic prostaglandin analog that is indicated for elevated IOP associated with open-angle glaucoma or ocular hypertension. The exact mechanism by which it reduces IOP is unknown, but it is thought to increase uveoscleral outflow.

Contributor Information and Disclosures

Mauricio E Pons, MD Associate Physician, California Retina Associates

Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.


Bret A Hughes, MD Assistant Professor, Department of Ophthalmology, Kresge Eye Institute, Wayne State University

Bret A Hughes, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Neil T Choplin, MD Adjunct Clinical Professor, Department of Surgery, Section of Ophthalmology, Uniformed Services University of Health Sciences

Neil T Choplin, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society, California Medical Association

Disclosure: Nothing to disclose.

  1. Harbour JW, Rubsamen PE, Palmberg P. Pars plana vitrectomy in the management of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1996 Sep. 114(9):1073-8. [Medline].

  2. Gnad HD. Athalamia as a late complication after keratoplasty on aphakic eyes. Br J Ophthalmol. 1980 Jul. 64(7):528-30. [Medline].

  3. Heatley CJ, Lim KS, Siriwardena D, Barton K. Malignant glaucoma as a complication of intravitreal triamcinolone acetonide. Acta Ophthalmol Scand. 2006 Oct. 84(5):712-3. [Medline].

  4. Kim JY, Ali R, Cremers SL, Yun SC, Henderson BA. Incidence of intraoperative complications in cataract surgery performed by left-handed residents. J Cataract Refract Surg. 2009 Jun. 35(6):1019-25. [Medline].

  5. Epstein DL, Hashimoto JM, Anderson PJ, Grant WM. Experimental perfusions through the anterior and vitreous chambers with possible relationships to malignant glaucoma. Am J Ophthalmol. 1979 Dec. 88(6):1078-86. [Medline].

  6. Jain V, Maiti A, Shome D, Borse N, Natarajan S. Aspergillus-induced malignant glaucoma. Cornea. 2007 Jul. 26(6):762-3. [Medline].

  7. Burgansky-Eliash Z, Ishikawa H, Schuman JS. Hypotonous malignant glaucoma: aqueous misdirection with low intraocular pressure. Ophthalmic Surg Lasers Imaging. 2008 Mar-Apr. 39(2):155-9. [Medline].

  8. Ozeki N, Yuki K, Kimura I. Alternative approach to treating malignant glaucoma after trabeculectomy with unplanned zonulectomy. Clin Ophthalmol. 2010 May 6. 4:383-5. [Medline]. [Full Text].

  9. Trope GE, Pavlin CJ, Bau A, Baumal CR, Foster FS. Malignant glaucoma. Clinical and ultrasound biomicroscopic features. Ophthalmology. 1994 Jun. 101(6):1030-5. [Medline].

  10. Duy TP, Wollensak J. Ciliary block (malignant) glaucoma following posterior chamber lens implantation. Ophthalmic Surg. 1987 Oct. 18(10):741-4. [Medline].

  11. Wu ZH, Wang YH, Liu Y. Management strategies in malignant glaucoma secondary to antiglaucoma surgery. Int J Ophthalmol. 2016. 9 (1):63-8. [Medline].

  12. Malukiewicz G, Stafiej J. Malignant glaucoma and central retinal vein occlusion after Nd: YAG laser posterior capsulotomy. Klin Oczna. 2011. 113(7-9):254-7. [Medline].

  13. Shaffer RN. The role of vitreous detachment in aphakic and malignant glaucoma. Trans Am Acad Ophthalmol Otol. 1954. 58:217.

  14. Levene R. A new concept of malignant glaucoma. Arch Ophthalmol. 1972 May. 87(5):497-506. [Medline].

  15. Quigley HA. Malignant glaucoma and fluid flow rate. Am J Ophthalmol. 1980 Jun. 89(6):879-80. [Medline].

  16. Fatt I. Hydraulic flow conductivity of the vitreous gel. Invest Ophthalmol Vis Sci. 1977 Jun. 16(6):565-8. [Medline].

  17. Artes PH, Chauhan BC. Signal/noise analysis to compare tests for measuring visual field loss and its progression. Invest Ophthalmol Vis Sci. 2009 May 20. [Medline].

  18. Shen CJ, Chen YY, Sheu SJ. Treatment course of recurrent malignant glaucoma monitoring by ultrasound biomicroscopy: a report of two cases. Kaohsiung J Med Sci. 2008 Nov. 24(11):608-13. [Medline].

  19. Herschler J. Laser shrinkage of the ciliary processes. A treatment for malignant (ciliary block) glaucoma. Ophthalmology. 1980 Nov. 87(11):1155-9. [Medline].

  20. Song J, Castellarin A, Song M, Song A. Repositioning of glaucoma tubes into the pars plana for refractory malignant glaucoma: a case report. J Med Case Rep. 2013 Apr 11. 7(1):102. [Medline]. [Full Text].

  21. Byrnes GA, Leen MM, Wong TP, Benson WE. Vitrectomy for ciliary block (malignant) glaucoma. Ophthalmology. 1995 Sep. 102(9):1308-11. [Medline].

  22. Zacharia PT, Abboud EB. Recalcitrant malignant glaucoma following pars plana vitrectomy, scleral buckle, and extracapsular cataract extraction with posterior chamber intraocular lens implantation. Ophthalmic Surg Lasers. 1998 Apr. 29(4):323-7. [Medline].

  23. Debrouwere V, Stalmans P, Van Calster J, Spileers W, Zeyen T, Stalmans I. Outcomes of different management options for malignant glaucoma: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2012 Jan. 250(1):131-41. [Medline].

  24. Feng YF, Wang DD, Zhao YE, Li JH, Savini G, Huang JH. Surgical management of malignant glaucoma with white cataract in nanophthalmos. J Cataract Refract Surg. 2013 Nov. 39(11):1774-7. [Medline].

  25. Lynch MG, Brown RH, Michels RG, Pollack IP, Stark WJ. Surgical vitrectomy for pseudophakic malignant glaucoma. Am J Ophthalmol. 1986 Aug 15. 102(2):149-53. [Medline].

  26. Żarnowski T, Wilkos-Kuc A, Tulidowicz-Bielak M, Kalinowska A, Zadrożniak A, Pyszniak E, et al. Efficacy and safety of a new surgical method to treat malignant glaucoma in pseudophakia. Eye (Lond). 2014 Jun. 28 (6):761-4. [Medline].

  27. Cronemberger S, Lourenço LF, Silva LC, Calixto N, Pires MC. Prognosis of glaucoma in relation to blindness at a university hospital. Arq Bras Oftalmol. 2009 Apr. 72(2):199-204. [Medline].

  28. Arya SK, Sonika, Kochhar S, Kumar S, Kang M, Sood S. Malignant glaucoma as a complication of Nd:YAG laser posterior capsulotomy. Ophthalmic Surg Lasers Imaging. 2004 May-Jun. 35(3):248-50. [Medline].

  29. Azuara-Blanco A, Dua HS. Malignant glaucoma after diode laser cyclophotocoagulation. Am J Ophthalmol. 1999 Apr. 127(4):467-9. [Medline].

  30. Azuara-Blanco A, Katz LJ, Gandham SB, Spaeth GL. Pars plana tube insertion of aqueous shunt with vitrectomy in malignant glaucoma. Arch Ophthalmol. 1998 Jun. 116(6):808-10. [Medline].

  31. Berger RR, Kenyeres AM, Powell DA. Suspected ciliary block associated with Viscoat use. J Cataract Refract Surg. 1999 Apr. 25(4):594-6. [Medline].

  32. Brown RH, Lynch MG, Tearse JE, Nunn RD. Neodymium-YAG vitreous surgery for phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1986 Oct. 104(10):1464-6. [Medline].

  33. Cashwell LF, Martin TJ. Malignant glaucoma after laser iridotomy. Ophthalmology. 1992 May. 99(5):651-8; discussion 658-9. [Medline].

  34. Cekic O, Batman C. Pars plana vitrectomy in the treatment of phakic and pseudophakic malignant glaucoma. Arch Ophthalmol. 1998 Jan. 116(1):118. [Medline].

  35. Chandler PA, Simmons RJ, Grant WM. Malignant glaucoma. Medical and surgical treatment. Am J Ophthalmol. 1968 Sep. 66(3):495-502. [Medline].

  36. Dugel PU, Heuer DK, Thach AB, Baerveldt G, Lee PP, Lloyd MA, et al. Annular peripheral choroidal detachment simulating aqueous misdirection after glaucoma surgery. Ophthalmology. 1997 Mar. 104(3):439-44. [Medline].

  37. Epstein DL, Steinert RF, Puliafito CA. Neodymium-YAG laser therapy to the anterior hyaloid in aphakic malignant (ciliovitreal block) glaucoma. Am J Ophthalmol. 1984 Aug 15. 98(2):137-43. [Medline].

  38. Greenfield DS, Tello C, Budenz DL, Liebmann JM, Ritch R. Aqueous misdirection after glaucoma drainage device implantation. Ophthalmology. 1999 May. 106(5):1035-40. [Medline].

  39. Hardten DR, Brown JD. Malignant glaucoma after Nd:YAG cyclophotocoagulation. Am J Ophthalmol. 1991 Feb 15. 111(2):245-7. [Medline].

  40. Johnson DH. Options in the management of malignant glaucoma. Arch Ophthalmol. 1998 Jun. 116(6):799-800. [Medline].

  41. Levene RZ. Current concepts of malignant glaucoma. Ophthalmic Surg. 1986 Aug. 17(8):515-8, 520. [Medline].

  42. Liebmann JM, Weinreb RN, Ritch R. Angle-closure glaucoma associated with occult annular ciliary body detachment. Arch Ophthalmol. 1998 Jun. 116(6):731-5. [Medline].

  43. Little BC. Treatment of aphakic malignant glaucoma using Nd:YAG laser posterior capsulotomy. Br J Ophthalmol. 1994 Jun. 78(6):499-501. [Medline].

  44. Luntz MH, Rosenblatt M. Malignant glaucoma. Surv Ophthalmol. 1987 Sep-Oct. 32(2):73-93. [Medline].

  45. Margo CE, Hamed LM. Diagnostic Problems in Clinical Ophthalmology. Saunders; 1993. 293.

  46. Massicotte EC, Schuman JS. A malignant glaucoma-like syndrome following pars plana vitrectomy. Ophthalmology. 1999 Jul. 106(7):1375-9. [Medline].

  47. Mastropasqua L, Ciancaglini M, Carpineto P, Lobefalo L, Gallenga PE. Aqueous misdirection syndrome: a complication of neodymium: YAG posterior capsulotomy. J Cataract Refract Surg. 1994 Sep. 20(5):563-5. [Medline].

  48. McClellan KA, Billson FA. Spontaneous onset of ciliary block glaucoma in acute hydrops in Down's syndrome. Aust N Z J Ophthalmol. 1988 Nov. 16(4):325-7. [Medline].

  49. Melamed S, Cahane M, Gutman I, Blumenthal M. Postoperative complications after Molteno implant surgery. Am J Ophthalmol. 1991 Mar 15. 111(3):319-22. [Medline].

  50. Park M, Unigame K, Kiryu J, Kondo T. Management of a patient with pseudophakic malignant glaucoma; role of ultrasound biomicroscopy. Br J Ophthalmol. 1996 Jul. 80(7):676-7. [Medline].

  51. Pecora JL. Malignant glaucoma worsened by miotics in a postoperative angle-closure glaucoma patient. Ann Ophthalmol. 1979 Sep. 11(9):1412-4. [Medline].

  52. Quigley HA. Angle-closure glaucoma-simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am J Ophthalmol. 2009 Nov. 148(5):657-669.e1. [Medline].

  53. Reed JE, Thomas JV, Lytle RA, Simmons RJ. Malignant glaucoma induced by an intraocular lens. Ophthalmic Surg. 1990 Mar. 21(3):177-80. [Medline].

  54. Robinson A, Prialnic M, Deutsch D, Savir H. The onset of malignant glaucoma after prophylactic laser iridotomy. Am J Ophthalmol. 1990 Jul 15. 110(1):95-6. [Medline].

  55. Ruben S, Tsai J, Hitchings RA. Malignant glaucoma and its management. Br J Ophthalmol. 1997 Feb. 81(2):163-7. [Medline].

  56. Schwartz AL, Anderson DR. Malignant glaucoma" in an eye with no antecedent operation or miotics. Arch Ophthalmol. 1975 May. 93(5):379-81. [Medline].

  57. Tello C, Chi T, Shepps G, Liebmann J, Ritch R. Ultrasound biomicroscopy in pseudophakic malignant glaucoma. Ophthalmology. 1993 Sep. 100(9):1330-4. [Medline].

  58. Tomey KF, Senft SH, Antonios SR, Shammas IV, Shihab ZM, Traverso CE. Aqueous misdirection and flat chamber after posterior chamber implants with and without trabeculectomy. Arch Ophthalmol. 1987 Jun. 105(6):770-3. [Medline].

  59. Tsai JC, Barton KA, Miller MH, Khaw PT, Hitchings RA. Surgical results in malignant glaucoma refractory to medical or laser therapy. Eye (Lond). 1997. 11 ( Pt 5):677-81. [Medline].

Phakic malignant glaucoma.
Malignant glaucoma subsequently developed in a 70-year-old man with a history of nanophthalmos who underwent cataract extraction with spherical piggyback IOL implantation.
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