TREATMENTS FOR GLAUCOMA

MEDICATIONS
    Prescription drops are the first attack in treating glaucoma.

ALPHA AGONISTS:

    1. Epifrin (Epinephrine) 0.1%
    2. Dipivefrin 0.1%
    Contraindications: Heart problems
    Side Effects: Allergies/ Decreased Vision/Headaches/Increased Heart Rate

ALPHA ADRENERGIC:

    1.Aphagan = Brimonidine 0.2%
    2. Apraclonidine = Iopidine 0.5%
    3. Dipivefrin = Propine 0.1%
    Contraindications:   Severe Vascular Disease/ Narrow Angles
    Side Effects: Vasovagal (heart problems) /Allergy

BETA BLOCKERS:

    1. Betaoptic S = Betaxolol 0.25% in (2.5/5/10 ml)
    2. Betagan = Levobunolol 0.25/0.5% (5/10 ml)
    3. Timolol = Timoptic 0.25/0.5% MOST COMMON!
    4. Timoptic XE 0.25/0.5% (2.5/5/10/15 ml)
    5. Careolol = Ocupress 1.0% (5/10 ml)
    6. Metipranolol = Optipranolol 0.3% (5/10 ml)
    7. Betimol = Timolol
    Contraindications: Asthma/Brachycardia/Chronic Heart Failure/Cardiac failure/
        Diabetics with hypoglycemia
    Side Effects: Blur/allergy/Cornea Cell Damage/ Decreased sex drive
                     Possible dizziness/Vertigo/Pulmonary distress/Cardiac

CARBONIC ANHYRASE INHIBITORS:

        ORAL
         1. Acetazolamide = Diamox 125/250/500 mg (Capsules)
         2. Methazolamide = Neptazane 25/50 mg (Capsules)
         3. Osmoglyn (Drinkable Solution)
    Contraindications:  People with kidney stones/renal issues/Sulfa Allergies
    Side Effects: Lethargy/Gastro-intestinal problems/Impotence/A metal taste
    Be careful if you have blood disorders
         TOPICAL
            1. Trusopt = Dorzolamide 2.0%
            2. Azopt = Brinzolamide 1.0%

CHOLINERGIC AGONISTS/MIOTICS

    1.  Pilocarpine 0.5 to 4%
    2. Ocusert Pilo-20 or -40
    Contraindications: Young people don't do well with small pupils/Retinal Pathology/
        Subcapsular cataract formation
    Side Effects: Miosis/Brow ache/Retinal Detachmet/Decreased night vision

PROSTAGLANDIN ANALOGS:

    1.  Lumigan 
    2.  Travatan
    3.  Xalatan
    Contraindications:   These should not be used if your eye is inflamed or you have iritis or
       even conjunctivitis.
    Side Effects: May darken your iris.  If you have a blue eye it can turn brown.  This is more important if you are only treating one eye!  Lash growth or making your eyelashes thicker occures in 5-10% or patients.

COMBO DRUGS:

  Cosopt (Dorzolomdide + Timolol)

LASER SURGERY 

Trabeculoplasty:

This is a laser surgery often used to lower pressures.  The laser beam is directed at the angle between your cornea and iris.  This opens holes in the trabecular meshwork and helps decrease pressure.

Laser Iridotomy:

This is where a laser is aimed at the colored part of your eye.  It opens a hole from the front chamber to the rear chamber.  This form of laser is used for rapid onset glaucoma and also preventatively for patients with closed angle glaucoma.

SURGERY

    Several surgeries are available for glaucoma.
 
Laser Iridectomy:

Laser iridectomy is when you laser a small hole in the iris (the colored part of your eye).  This allows fluid to flow out, decreasing the pressure.  This is often done to prevent pressures from spiking for patients with narrow angles.

Laser Trabeculoplasty:

A laser is aimed into the region between your cornea and your iris. Numerous small holes are made in this region (called the Trabecular Meshwork).  This allows increased outflow of fluid.

Surgical Bleb:

This surgery is done when most other treatments are not working well.  A specialized glaucoma surgeon will form your tissue into a "bleb".  What the surgeon really is doing, is making a passageway for fluid to leak out of your eye - to decrease the pressure.