Medication Summary
Medications that decrease the aqueous production or increase the outflow are used as initial treatment in adult-onset secondary congenital glaucoma.
Beta-blockers, parasympathomimetics, alpha-adrenergic agonists, prostaglandin analogs, and carbonic anhydrase inhibitors can be used.
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 (AKBeta, Betagan)
Nonselective beta-adrenergic blocking agent that lowers intraocular pressure by reducing aqueous humor production and possibly increases outflow of aqueous humor.
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. Should be avoided in children younger than 3 years.
Prostaglandin F2-alpha analogs
Class Summary
These agents decrease IOP by increasing uveoscleral outflow.
Latanoprost (Xalatan, Xelpros)
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.
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.
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)
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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Axenfeld-Rieger syndrome with iris atrophy, corectopia, and pseudopolycoria.
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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.
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Female infant with Sturge-Weber syndrome. Facial port-wine nevus involves the left eyelid, associated with ipsilateral buphthalmos.
