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Pseudoexfoliation Glaucoma Medication

  • Author: Mauricio E Pons, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jul 27, 2015
 

Medication Summary

Medical therapy is aimed at lowering IOP.

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Beta-adrenergic receptor blocking agents

Class Summary

Topical beta-blockers that reduce elevated and normal IOP, with or without glaucoma.

Timolol ophthalmic (Timoptic, Betimol, Istalol)

 

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

Betaxolol ophthalmic (Betoptic)

 

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

Carteolol ophthalmic (Cartrol, Ocupress)

 

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

Levobunolol hydrochloride (Betagan, AKBeta)

 

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

Metipranolol (OptiPranolol)

 

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

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Cholinergic parasympathomimetic agents

Class Summary

Pilocarpine is a miotic agent. It reduces IOP, decreases pupillary movement, and increases aqueous outflow. Pilocarpine 2% qhs has been recommended as a first-line agent.[47]

Pilocarpine ophthalmic (Isopto)

 

Produces miosis through direct stimulation of muscarinic neuroreceptors. Also produces contraction of iris sphincter, causing opening of trabecular meshwork spaces to facilitate outflow of aqueous humor.

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Prostaglandins

Class Summary

May decrease IOP by increasing outflow of aqueous humor.

Latanoprost (Xalatan)

 

Prostaglandin F2-alpha agonist. Decreases IOP by increasing uveoscleral outflow.

Travoprost ophthalmic solution (Travatan, Travatan Z)

 

Prostaglandin F2-alpha analog and selective FP prostanoid receptor agonist. Exact mechanism of action unknown but believed to reduce IOP by increasing uveoscleral outflow.

Bimatoprost (Lumigan)

 

Prostaglandin agonist that selectively mimics effects of naturally occurring substances, prostamides. Exact mechanism of action unknown but believed to reduce IOP by increasing outflow of aqueous humor through trabecular meshwork and uveoscleral routes. Used to reduce IOP in open-angle glaucoma or ocular hypertension.

Unoprostone isopropyl (Rescula)

 

Prostaglandin F2-alpha analog and selective FP prostanoid receptor agonist. Exact mechanism of action unknown but believed to reduce IOP by increasing uveoscleral outflow.

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Sympathomimetics

Class Summary

Decrease aqueous production and increase outflow facility.

Dipivefrin hydrochloride (AKPro, Propine)

 

Converted to epinephrine in eye by enzymatic hydrolysis. Appears to act by decreasing aqueous production and enhancing outflow facility. Has same therapeutic effect as epinephrine with fewer local and systemic adverse effects. May be used as an initial therapy or as an adjunct with other antiglaucoma agents for the control of IOP.

Epinephrine (Glaucon)

 

Lower IOP by increasing outflow and reducing production of aqueous humor. Used as adjunct to miotic or beta-blocker therapy. Combination of miotic and sympathomimetic has additive effects in lowering IOP.

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Alpha2-adrenergic receptor antagonists

Class Summary

Reduce IOP.

Apraclonidine HCl (Iopidine)

 

Decreases IOP by reducing aqueous humor production. Generally used in short-term therapy.

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Alpha-adrenergic receptor agonists

Class Summary

Brimonidine tartrate is an alpha-adrenergic receptor agonist that reduces IOP.

Brimonidine (Alphagan P)

 

Reduces aqueous humor production and may have a small effect on increasing uveoscleral outflow.

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Carbonic anhydrase inhibitors

Class Summary

Brinzolamide is a sulfonamide that reduces IOP.

Brinzolamide (Azopt)

 

Inhibits the enzyme CA in the ciliary process, decreasing aqueous humor secretion.

Dorzolamide hydrochloride (Trusopt)

 

Sulfonamide that reduces IOP. Inhibits enzyme CA in the ciliary process, decreasing aqueous humor secretion.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Babak Eliassi-Rad, MD Assistant Professor, Director of Glaucoma Service, Department of Ophthalmology, Boston University School of Medicine

Babak Eliassi-Rad, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

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

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

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Pseudoexfoliative material can be seen in this eye with pseudoexfoliation glaucoma. Courtesy of S. Fabian Lerner, MD.
 
 
 
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