Glaucoma treatment: using drops to manage glaucoma
When drops are prescribed they should be used forever. Unlike antibiotics, it is not a course of treatment.
There are 4 main groups of glaucoma eye drops:
Prostaglandin analogues- latanoprost, travoprost, bimatoprost & tafluprost
These are used once daily at night. They are the most effective of all glaucoma drops. They have few side effects and are well tolerated. They make the eyelashes grow longer and thicker and can cause some colour change in the iris or the skin around the eye.
These drops are used twice daily and were the gold standard drops until the PGAs were discovered in 2001. They are effective and are usually the second line. If you need more than a PGA to control the IOP, it is usual to co-prescribe the PGA and Beta-blocker in a single bottle. This makes it easier and more convenient for you to take your treatment. This is used twice daily. Patients with asthma or very slow heart rates usually cannot have beta-blockers. Thus, it is important that you tell us if you have these conditions at your consultation.
Iopidine is used at the time of glaucoma laser treatments as it works very quickly, but the effect does not last very long. Brimonidine lasts much longer as is used commonly as the third line drop in glaucoma. It is effective but can make the eye quite red, even after some months of use with some patients developing an allergy to it. In these cases the drop is stopped and the redness resolves.
Carbonic anhydrase inhibitors
Dorzolamide and Brinzolamide are used 2-3 times daily and are commonly prescribed in combination with beta blockers.
If you have any questions about your drops or the schedule for taking them, please ask as it can be confusing when you start drops or if they are changed.
My drops really sting when I put them in and they make my eyes red, what shall I do?
It is common for newly prescribed glaucoma drops to cause some redness at first. It is unusual to be allergic to the drug in the bottle of drops within the first 2 weeks. The redness is usually mild and settles after the first 2 weeks of treatment. So continue with them for at least 2 weeks if you feel able to. If the redness and discomfort persist beyond the first month, it is likely that your eyes are sensitive to the preservative in the eye drop bottle. This keeps the bottle free from bacteria. It may be that a preservative-free glaucoma drop is better for you. Preservative-free (PF) preparations are now available for most glaucoma drops and Ms Crawley can recommend a suitable one for you.
How do I get a new bottle of drops?
It is important that you order replacement bottles in good time from your GP. The drops quickly wear off if not used daily allowing the IOP to rise to a potentially damaging level once more.
If your glaucoma drops are causing you problems, please let your specialist know so that a suitable alternative can be found. Do not go without the glaucoma drops. It is usually possible to find one that is both effective and comfortable to use.
More about Laura Crawley
Ms Laura Crawley is a Consultant Ophthalmologist at Clinica London. Her special expertise is in treating glaucoma patients as well as patients with glaucoma and cataracts. She has a lot of experience in treating glaucoma and has published extensively in scientific journals and on medical education. She still does a lot of emergency operations at the emergency department at the Charing Cross and Western Eye Hospitals for the NHS. At Clinica London, she is responsible for glaucoma patients and glaucoma patients with cataracts. She also sees patients with general eye problems.