Unilateral Glaucoma Medication

Medications used to decrease aqueous production include beta-blockers (topical), carbonic anhydrase inhibitors (topical and/or oral), and alpha 2-agonists.

Class Summary

Decrease IOP by reducing aqueous production. Reduce elevated and normal IOP, with or without glaucoma.

Timolol 0.25%, 0.5% (Timoptic, Timoptic XE, Blocadren)

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

Levobunolol 0.25% or 0.5% (AK Beta, Betagan)

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

Metipranolol 0.3% (OptiPranolol)

Beta-adrenergic blocker that has little or no intrinsic sympathomimetic effects and membrane-stabilizing activity. Has little local anesthetic activity. Reduces IOP by reducing production of aqueous humor.

Carteolol 1.0% (Ocupress)

Blocks beta 1- and beta 2-receptors and has mild intrinsic sympathomimetic effects.

Betaxolol 0.25% or 0.5% (Betoptic)

Selectively blocks beta 1-adrenergic receptors with little or no effect on beta 2-receptors. Reduces IOP by reducing production of aqueous humor.

Class Summary

Act to decrease aqueous humor formation.

Brimonidine (Alphagan)

Selective alpha 2-receptor that reduces aqueous humor formation and increases uveoscleral outflow.

Apraclonidine 0.5% or 1% (Iopidine)

Reduces elevated, as well as normal, IOP whether or not accompanied by glaucoma. A relatively selective alpha-adrenergic agonist that does not have significant local anesthetic activity. Has minimal cardiovascular effects.

Class Summary

Enzyme found in many tissues of the body, including the eye. Catalyzes a reversible reaction where carbon dioxide becomes hydrated and carbonic acid dehydrated. By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit CA in the ciliary processes of the eye. This effect decreases aqueous humor secretion, reducing IOP.

Acetazolamide (Diamox, Diamox Sequels)

Inhibits enzyme CA, reducing the rate of aqueous humor formation, which, in turn, reduces IOP. Used for adjunctive treatment of chronic simple (open angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery desired to lower IOP.

Dorzolamide 2% (Trusopt)

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. Reversibly inhibits CA, reducing hydrogen ion secretion at renal tubule and increasing renal excretion of sodium, potassium bicarbonate, and water to decrease production of aqueous humor.

Methazolamide (Neptazane)

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

Brinzolamide 1% (Azopt)

Catalyzes reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid. 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.

Class Summary

These agents may decrease intraocular pressure by increasing the outflow of aqueous humor.

They are administered once per day (except for unoprostone, which is administered twice daily). Potential adverse effects of these medications are similar to latanoprost (eg, eyelash growth, increased iris pigmentation). These agents are considered by some glaucoma specialists as first-line agents for glaucoma, mainly because of the lack of systemic adverse effects.

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 (Travatan)

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 ophthalmic solution (Rescula)

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.