Pseudoexfoliation Syndrome (Pseudoexfoliation Glaucoma) Medication

Updated: Oct 23, 2018
  • Author: Mauricio E Pons, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Medication

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, Betoptic S)

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 (AKBeta, Betagan)

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. [48]

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, Xelpros)

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 (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 (Trusopt)

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

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