Medicines to Treat Glaucoma

Definition

Glaucoma is not simply an eye disease; rather it can be defined as a subtle pathological condition that can cause irreversible damage to the optic nerve, responsible for a progressive decrease in vision, up to blindness. Glaucoma is characterized, most often, by an increase in intraocular pressure.

open angle glaucoma → most common form consisting of progressive loss of vision
closed angle glaucoma → less common form, which tends to come on suddenly

Causes

What is certain is that the abnormal increase in intraocular pressure is closely related to the damage to the optic nerve that characterizes glaucoma; the increase in pressure depends on damage to the outflow systems from the aqueous humor. In narrow-angle glaucoma, the outflow is suddenly blocked.
However, the real reason from which the disease originates is still under study.

• Risk factors: diabetes, migraine, age> 40 years, ocular hypertension, genetic predisposition, prolonged administration of steroids, history of ocular tumors

Symptoms

Unfortunately, in most patients with glaucoma, the disease is diagnosed late, when it is already in the advanced stage: in fact, especially in the open-angle form, glaucoma is asymptomatic in the initial stage.

Closed-angle glaucoma can cause visual impairment, eye pain, difficulty focusing, nausea, vomiting.

The information on Glaucoma - Glaucoma Treatment Drugs is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Glaucoma - Glaucoma Medicines.

Medicines

Of all the diseases that affect the eyes, glaucoma represents the second cause of blindness: for this reason, an eye examination is absolutely necessary at the first manifestation of symptoms. As we have seen, however, in most cases glaucoma tends to become symptomatic only at an advanced stage; in this regard, periodic eye checks are recommended, especially in people who have already passed the age of 40.
For the treatment of glaucoma drugs that reduce intraocular pressure are considered first choice: among the most used we cannot forget the beta-blockers, prostaglandin analogues and carbonic anhydrase inhibitors.

The following are the classes of drugs most used in the therapy against glaucoma, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Beta blockers: these drugs are the most widely used for the treatment of open-angle glaucoma; they are particularly useful for lowering intraocular pressure, since they carry out their therapeutic action directly on the aqueous humor, reducing its production. Although beta-blocking drugs can be taken orally or applied locally, this last mode of use is preferable. , considering the countless side effects derived from oral administration.

• Betaxolol (eg Betoptic, Kerlon): instill one or two drops of the drug in the eye affected by glaucoma. Repeat the application twice a day.
• Levobunolol (eg Vistagan): the drug is available in 0.5% and 0.25% solution. Apply one or two drops a day to the diseased eye or eyes, in full compliance with the instructions of the doctor.
• Metoprolol (eg. Seloken): apply a drop of product, twice a day.
• Timolol: timolol is available alone (Blocadren) or in combination with other active ingredients, such as travoprost (+ timolol: eg. Duo-Trav), brinzolamide (+ timolol: eg. Azarga), bimatoprost (+ timolol: eg, Ganfort)

Prostaglandin analogues: these drugs are used to treat glaucoma, even if they are second-line active ingredients, that is to say, indicated in case the beta blockers cannot be taken by the patient. The analogues of PG carry out their therapeutic activity by favoring the outflow of aqueous humor, consequently the intraocular pressure tends to normalize. A typical side effect of these substances is the hyperpigmentation of the iris.

• Latanoprost (eg Galaxia, Xalost, Glak): it is recommended to apply one drop in each eye affected by glaucoma, preferably in the morning.
• Travoprost (eg Travatan): instill a drop of drug once a day, preferably in the evening. Do not use under the age of 18.
• Bimatoprost (eg Lumigan): is used alone or in combination with timolol (eg the aforementioned drug Ganfort). It is recommended to apply one drop in the diseased eye, or both, once a day, preferably in the morning.

Sympathomimetics: another category of drugs used as a second line for the treatment of glaucoma are precisely sympathomimetics, which mimic the activity of adrenaline and noradrenaline.

• Brimonidina (eg Alphagan, Combigan, Brimoftal): the drug is a 2-alpha adrenergic agonist, used in therapy for the treatment of glaucoma in order to lower the pressure inside the eye. The drug is used as an alternative to beta-blockers, if the latter are contraindicated for the patient. It is possible, for some patients, to apply this drug in combination with timolol. Apply the drug two or three times a day.
• Apraclonidine (eg. Iopidine): like the previous one, apraclonidine also belongs to the class of 2-alpha adrenergic agonists. 0.5-1% eye drops are generally used to balance the intraocular pressure. The most suitable dose as a complementary treatment for the chronic glaucoma treatment is: 1 drop, three times a day, for one month, using a 0.5% solution.
• Dipivephrine (eg Propine): Compared to adrenaline, this pro-drug appears to be able to cross the cornea faster, and to be activated just as quickly. Instill two drops a day in the diseased eye (or both).
• Pilocarpine (eg Dropilton, Piloca C FN, Salagen): in the past, pilocarpine was for a long time the most used drug for the treatment of glaucoma. However, the considerable side effects, given by the application in the eye of a pilocarpine-based eye drops, increasingly removed this drug from the most suitable therapies; among the side effects associated with its use, we cannot forget the lacrimation, the refraction variations and the conjunctival hyperaemia. In any case, the most used dose for the treatment of glaucoma is 1-2 drops, to be applied directly in the sick eye. in the form of eye drops, 3-4 times a day.

Carbonic anhydrase inhibitors: used as a second line in glaucoma therapy, these drugs perform their therapeutic action by inhibiting the formation of aqueous humor. They can be used both as an alternative to beta-blockers (for patients who are allergic, intolerant or hypersensitive), and as a complement to a therapy with the same beta-blockers (if there are no contraindications for the patient).

• Acetazolamide (eg. Diamox): in addition to being used for the treatment of epilepsy, this drug is also indicated for the treatment of glaucoma, for the reduction of intraocular pressure. Apply the product at the dosage of one drop in the sick eye (or in both if suffering from glaucoma) two to three times a day.
• Brinzolamide (eg Azopt). Also available in combination with timolol: (eg Azarga) it is recommended to instill the drug twice a day. If the doctor deems it appropriate, apply the drug three times a day.
• Dorzolamide (eg. Dorzostill, Dorzolamide DOC, Trusopt): when used alone for the treatment of glaucoma, it is recommended to instill the drug 3 times a day. If the patient with glaucoma uses the drug in combination with beta-blockers, apply the product twice a day.