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Secondary Congenital Glaucoma Medication

  • Author: Inci Irak Dersu, MD, MPH; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 14, 2014
 

Medication Summary

Medications that decrease the aqueous production or increase the outflow are used as initial treatment in adult-onset secondary congenital glaucoma.

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Beta-adrenergic blockers

Class Summary

These agents decrease aqueous production and IOP.

Timolol ophthalmic (Timoptic, Timoptic XE, Betimol)

 

May reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor or by outflow.

Levobunolol (Betagan)

 

Nonselective beta-adrenergic blocking agent that lowers intraocular pressure by reducing aqueous humor production and possibly increases outflow of aqueous humor.

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Alpha2-adrenergic agonists

Class Summary

These agents decrease IOP.

Brimonidine (Alphagan, Alphagan-P 0.15% and 0.10 %)

 

Lowers IOP by decreasing aqueous production and increasing uveoscleral outflow.

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Prostaglandin F2-alpha analogs

Class Summary

These agents decrease IOP by increasing uveoscleral outflow.

Latanoprost 0.005% (Xalatan)

 

May decrease IOP by increasing outflow of aqueous humor.

Bimatoprost ophthalmic solution (Lumigan)

 

A prostamide analogue with ocular hypotensive activity. Mimics the IOP-lowering activity of prostamides via the prostamide pathway. Used to reduce IOP in open-angle glaucoma or ocular hypertension.

Travoprost ophthalmic solution 0.004% (Travatan, Travatan Z)

 

Prostaglandin F2-alpha analog. Selective FP prostanoid receptor agonist believed to reduce IOP by increasing uveoscleral outflow. Used to treat open-angle glaucoma or ocular hypertension.

Unoprostone (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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Miotics

Class Summary

These agents decrease IOP by increasing aqueous humor outflow.

Pilocarpine ophthalmic (Adsorbocarpine, Akarpine, Isopto Carpine, Pilocar, Pilostat)

 

Increase outflow by pulling the longitudinal part of the ciliary muscle. Indirect-acting miotics are used less commonly.

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Carbonic anhydrase inhibitors

Class Summary

Decrease aqueous production and IOP. May use temporarily before surgery or longer, if patient tolerates it. Concomitant use of topical and systemic carbonic anhydrase inhibitors is not recommended.

Acetazolamide (Diamox, Diamox Sequels)

 

Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP. Acetazolamide increases sickling in patients with sickle cell trait or disease; in these patients, methazolamide may be safer.

Methazolamide (Neptazane)

 

Reduces aqueous humor formation by inhibiting enzyme carbonic anhydrase, which results in decreased IOP.

Brinzolamide (Azopt)

 

Inhibits carbonic anhydrase, which, in turn, leads to a decrease in aqueous humor secretion. May use concomitantly with other topical ophthalmic drug products to lower IOP. If more than one topical ophthalmic drug is being used, administer drugs at least 10 min apart.

Dorzolamide (Trusopt) 2%)

 

Used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one ophthalmic drug is being used, administer the drugs at least 10 min apart. Inhibits carbonic anhydrase, which, in turn, leads to a decrease in aqueous humor secretion.

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Contributor Information and Disclosures
Author

Inci Irak Dersu, MD, MPH Associate Professor of Clinical Ophthalmology, State University of New York Downstate College of Medicine; Attending Physician, SUNY Downstate Medical Center, Kings County Hospital, and VA Harbor Health Care System

Inci Irak Dersu, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

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

Andrew I Rabinowitz, MD Director of Glaucoma Service, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, American Society for Laser Medicine and Surgery, American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.

References
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  2. Iwach AG, Hoskins HD Jr, Hetherington J Jr, Shaffer RN. Analysis of surgical and medical management of glaucoma in Sturge-Weber syndrome. Ophthalmology. 1990 Jul. 97(7):904-9. [Medline].

  3. Agarwal HC, Sandramouli S, Sihota R, Sood NN. Sturge-Weber syndrome: management of glaucoma with combined trabeculotomy-trabeculectomy. Ophthalmic Surg. 1993 Jun. 24(6):399-402. [Medline].

  4. Kargi SH, Koc F, Biglan AW, Davis JS. Visual acuity in children with glaucoma. Ophthalmology. 2006 Feb. 113(2):229-38. [Medline].

  5. Yang LL, Lambert SR, Lynn MJ, Stulting RD. Surgical management of glaucoma in infants and children with Peters' anomaly: long-term structural and functional outcome. Ophthalmology. 2004 Jan. 111(1):112-7. [Medline].

  6. Allingham R, Damji K, Freedman S, Moroi S, Shafranov G. Developmental glaucomas with associated anomalies. Shields' Textbook of Glaucoma. 5th ed. Philadelphia, PA 19106: Lippincott Williams & Wilkins; 2005. 252-271.

  7. Cantor LB. Glaucoma associated with congenital disorders. Ritch R, ed. The Glaucomas. St Louis: Mosby; 1989. Vol 2: 931-960.

  8. Eibschitz-Tsimhoni M, Lichter PR, Del Monte MA, Archer SM, Musch DC, Schertzer RM, et al. Assessing the need for posterior sclerotomy at the time of filtering surgery in patients with Sturge-Weber syndrome. Ophthalmology. 2003 Jul. 110(7):1361-3. [Medline].

  9. Facts and Comparisons. Drug Facts and Comparisons. St Louis; 1999.

  10. Freedman S, Walton D. Glaucoma in infants and children. Nelson L, Olitsky S, eds. Harley's Pediatric Ophthalmology. 5th ed. Philadelphia, PA 19106: Lippincott Williams & Wilkins; 2005. Chapter 14, 285-304.

  11. Hittner HM. Aniridia. Ritch R, ed. The Glaucomas. St Louis: Mosby; 1989. Vol 2: 869-884.

  12. Kirwan JF, Shah P, Khaw PT. Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas. Ophthalmology. 2002 Feb. 109(2):316-23. [Medline].

  13. Schottenstein EM. Peter's anomaly. Ritch R, ed. The Glaucomas. St Louis: Mosby; 1989. Vol 2.: 897-903.

  14. Shields MB. Axenfeld-Rieger syndrome. Ritch R, ed. The Glaucomas. St Louis, Mo: Mosby; 1989. Vol 2: 885-95.

  15. Singh OS. Nanophthalmos guidelines for diagnosis and therapy. Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. 2000. Vol 4: 2846-2859.

  16. Walsh J, Muldoon T. Glaucoma associated with retinal vitreoretinal disorders. Ritch R, Shield MB, Krupin T, eds. The Glaucomas. 1996. Vol 2: 1055-1071.

  17. Weiss JS, Ritch R. Glaucoma in the phakomatoses. Ritch R, ed. The Glaucomas. St Louis: Mosby; 1989. Vol 2: 905-29.

  18. Wilson ME, Buckley EG, Kivlin JD. Pediatric Ophthalmology and Strabismus. AAO, Basic and Clinical Science Course. 1998. 6:330-345.

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Axenfeld-Rieger syndrome with iris atrophy, corectopia, and pseudopolycoria.
Female patient with plexiform neurofibroma (NF-1). Upper right eyelid involvement, associated with ipsilateral buphthalmos. In Image A (left), patient is aged 8 months; in Image B (right), patient is aged 8 years.
Female infant with Sturge-Weber syndrome. Facial port-wine nevus involves the left eyelid, associated with ipsilateral buphthalmos.
 
 
 
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