10 Treatments of Glaucoma

Prostaglandin analogues are eye fluid pressure-reducing medication. They're the primary treatment for glaucoma. They work by increasing the fluid drainage inside the eye to reduce pressure and are often combined with other treatments.

Using prostaglandins may cause darkening of the iris, especially in people with hazel or light brown eyes. This effect is usually permanent.

Two main types of beta-blockers are used to treat glaucoma: nonselective and cardioselective. Both are topical treatments that work to reduce pressure inside the eye by reducing fluid production. Respiratory symptoms such as bronchospasm, which narrows the airways, are the most serious potential side effect of beta-blockers.

Alpha agonists are applied as eye drops. They reduce pressure inside the eye in two ways. Like beta-blockers, they reduce the production of fluid, but alpha agonists also increase fluid drainage. The leading side effects of alpha agonists are burning or stinging eyes, headache, fatigue, dry mouth, and dry nose.

Carbonic anhydrase inhibitors are diuretics that may be prescribed topically or orally. They can be used alone or in combination with other glaucoma medications. Inhibitors decrease fluid pressure by changing the electrolyte and PH levels in the eye and increasing urination. The leading side effects are changes in taste or a bitter aftertaste, fatigue, headache, blurred vision, abdominal pain, or digestive upset, including nausea, vomiting, or diarrhea.

Parasympathomimetric medications cause smooth muscle cells in the eye to contract. This lowers pressure inside the eye by increasing the drainage of fluid. Many people do not tolerate treatment with parasympathomimetric medications well. Side effects may include intestinal cramps, bronchospasm, retinal detachment, ciliary cramps, and increased pupillary block.

Epinephrine reduces pressure inside the eye by both increasing drainage and decreasing fluid production to treat glaucoma alone or in combination with other medications. Doctors don't prescribe it for some of the less common types of the condition.

Side effects of epinephrine treatment include stinging or burning eyes, blurred vision, headaches, increased heart rate, high blood pressure, watery eyes, or the buildup of adrenochrome deposits in the eye.

Hyperosmotic agents quickly reduce pressure by lowering the fluid volume inside the eye to serve as an emergency treatment or before surgery. They are administered either orally or intravenously, and the effect is temporary, so they are not a substitute for other treatments.

Side effects may include fluid and electrolyte imbalance, dry mouth, metabolic acidosis, electrolyte loss, urinary retention, peripheral edema, headache, blurred vision, nausea or vomiting, hypotension, and tachycardia.

Combination drugs are so called because they combine two or more medications in one bottle. These medications may already have been prescribed separately, but they are now reformulated into a single treatment.

Combination drugs make treatment easier and more convenient, which helps people use them correctly and get the most benefit. This method of treatment also exposes patients to fewer preservatives and other ingredients that can cause adverse reactions.

Laser surgery uses a focused beam of light to treat glaucoma by increasing drainage or reducing the production of fluid to reduce pressure inside the eye. There are four main types of laser surgery used for different types and severity of glaucoma: selective laser trabeculoplasty, argon laser trabeculoplasty, laser peripheral iridotomy, and laser cyclophotocoagulation.

All four are usually carried out in the doctor's office or as a minor outpatient procedure in the hospital, with a recovery time of only days. Medications may still be necessary after surgery, but some people might be able to transition to a lower dosage. Side effects include a temporary increase in eye pressure, excessively low eye pressure, and a small risk of developing cataracts.

If a person's glaucoma has not responded to medications or laser surgery, they may require traditional surgery, of which there are three main types.

• Trabeculectomy treats open-angle glaucoma by creating a tiny opening in the top of the eye under the eyelid for excess fluid to drain.
• Glaucoma implant surgery treats congenital glaucoma, neovascular glaucoma, or glaucoma caused by injury. It implants a tiny tube called a shunt in the white part of the eye to drain extra fluid and lower pressure.
• Minimally invasive glaucoma surgery uses smaller incisions and interventions to treat less severe cases.