Treatments and drugs

By Mayo Clinic Staff

The goal of glaucoma treatment is to lower pressure in your eye (intraocular pressure). To treat your condition, doctors may lower your eye pressure, improve drainage of fluid in your eye or lower the amount of fluid produced in your eye.

Glaucoma can't be cured, and damage caused by the disease can't be reversed, but treatment and regular checkups can prevent vision loss in people with early glaucoma. If vision loss has already occurred, treatment can slow or prevent further vision loss.

Eyedrops

Glaucoma treatment often starts with medicated eyedrops. Be sure to use the drops exactly as prescribed. Otherwise, your optic nerve damage could get even worse. If your doctor prescribes more than one type of eyedrop, make sure to ask how long to wait between applications and to take the drops for as long as your doctor has prescribed them.

Because some of the eyedrops are absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for one to two minutes after putting the drops in. Press lightly at the corner of your eye near your nose to close the tear duct for one or two minutes, and wipe off any unused drops from your eyelid.

Most commonly prescribed eyedrops include:

  • Prostaglandins. Doctors often prescribe prostaglandins to treat open-angle glaucoma. These eyedrops increase the outflow of the fluid in your eye (aqueous humor) and reduce pressure in your eye. Examples include latanoprost (Xalatan) and bimatoprost (Lumigan). Possible side effects include mild reddening and stinging of the eyes and darkening of the iris, changes in the pigment of the eyelid skin and blurred vision.
  • Beta blockers. These reduce the production of fluid in your eye and pressure in your eye (intraocular pressure). Examples include timolol (Betimol, Timoptic) and betaxolol (Betoptic). Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. If you have lung or heart conditions, medications other than beta blockers may be recommended because beta blockers may worsen breathing problems.
  • Alpha-adrenergic agonists. These medications reduce the production of aqueous humor and increase outflow of the fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan). Possible side effects include irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth.
  • Carbonic anhydrase inhibitors. These are rarely used, but these medications may reduce the production of fluid in your eye. Examples include dorzolamide (Trusopt) and brinzolamide (Azopt). Possible side effects include frequent urination and a tingling sensation in the fingers and toes.
  • Miotic or cholinergic agents. These also increase the outflow of fluid in your eye. Examples include pilocarpine (Isopto Carpine) and carbachol (Isopto Carbachol). Possible side effects include smaller pupils, blurred or dim vision, or nearsightedness.
  • Combined medications. Sometimes doctors may prescribe a combined medication, such as a beta blocker and alpha adrenergic agonist, or a beta blocker and carbonic anhydrase inhibitor.

Oral medications

If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication, usually in the form of a carbonic anhydrase inhibitor, to reduce your eye pressure. This medication may cause side effects including frequent urination, a tingling sensation in the fingers and toes, depression, stomach upset, and kidney stones.

Research in treatment

Research to evaluate the effectiveness of medications and other glaucoma treatments and study potential new treatments for people with glaucoma is ongoing. Ongoing clinical trials are evaluating certain drugs that may help protect the optic nerve from damage associated with glaucoma.

Surgery

You may need surgery to treat glaucoma if you can't tolerate medications or if they're ineffective. Sometimes a single surgical procedure may not effectively lower your eye pressure. You may need to continue using eyedrops, or you may need another procedure.

Possible complications from glaucoma surgery include infection, inflammation, bleeding, abnormally high or low eye pressure, and loss of vision. Having eye surgery also may speed up the development of cataracts. Most of these complications can be effectively treated.

Surgeries that may be performed to treat glaucoma include:

  • Laser surgery. You may have an outpatient procedure called laser trabeculoplasty (truh-BEK-u-low-plas-tee) to treat open-angle glaucoma. After giving you a numbing eyedrop, your doctor uses a high-energy laser beam to open clogged drainage canals and help fluid drain more easily from your eye.

    Your doctor will need to check your eye pressure several times in the following weeks. It may take a few weeks before the full effect of the surgery becomes apparent.

    Laser surgery for glaucoma initially lowers pressure in your eye (intraocular pressure). Over time, however, the intraocular pressure may begin to increase.

  • Filtering surgery. If eyedrops and laser surgery aren't effective in controlling your eye pressure, you may need a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me).

    This procedure is performed in a hospital or an outpatient surgery center. You'll receive a medication to help you relax and usually an injection of anesthetic to numb your eye. Using small instruments under an operating microscope, your surgeon creates an opening in the sclera — the white of your eye — and removes a small piece of eye tissue at the base of your cornea through which fluid drains from your eye (the trabecular meshwork). The fluid in your eye can now freely leave the eye through this opening. As a result, your eye pressure will be lowered.

    Your surgery will be performed on one eye. If necessary, several weeks later you might have surgery on the other eye. You may need additional procedures or treatments, as the opening sometimes heals over or other changes occur in your optic nerve.

    Your doctor will check your eye during several follow-up visits, and you'll need to use antibiotic and anti-inflammatory eyedrops to fight infection and scarring of the newly created drainage opening.

    Another procedure performed within the eye removes a targeted strip of the trabecular meshwork with a small tool. Your surgeon inserts the tool into the eye's drainage canal through a small incision at the edge of the cornea and removes the small section of trabecular meshwork. This helps fluid drain more easily from your eye.

  • Drainage implants. Some people with advanced glaucoma, secondary glaucoma or children with glaucoma may be eligible for drainage implants. Drainage implant surgery takes place in a hospital or an outpatient clinic. In this procedure, your eye surgeon inserts a small tube in your eye to facilitate draining fluid (aqueous humor) from your eye to reduce the pressure.

In trabeculectomy and drainage implants, the fluid is directed to a blister (bleb) on the outer layer of your eyeball where it can be absorbed.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. When you're diagnosed with this condition, you'll need urgent treatment to reduce the pressure in your eye. This generally will require both medication and procedures.

You may have a procedure called a laser peripheral iridotomy. In iridotomy, doctors create a small hole in your iris using a laser so that fluid (aqueous humor) can flow through it and exit your eye. Doctors will evaluate your other eye and may recommend an iridotomy in it, because of the high risk that its drainage angle also will close in the future.

Oct. 02, 2012

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