Drugs Used in Glaucoma

Drugs for glaucoma include beta-blockers, prostaglandins, and carbonic anhydrase inhibitors to lower eye pressure.

Pharmacological Goal:

To reduce intraocular pressure by:

• Decreasing aqueous humor production, or
• Increasing aqueous humor outflow

Classes of Drugs Used in Glaucoma:

1. Prostaglandin Analogues (Increase outflow)

   • Latanoprost, Travoprost, Bimatoprost
   • Mechanism: Increase uveoscleral outflow
   • Side Effects: Iris pigmentation, eyelash growth

2. Beta-blockers (Decrease production)

   • Timolol, Betaxolol
   • Mechanism: Block beta receptors in ciliary body
   • Side Effects: Bradycardia, bronchospasm (due to systemic absorption)

3. Alpha-2 Agonists

   • Brimonidine, Apraclonidine
   • Mechanism: Decrease aqueous production and increase outflow
   • Side Effects: Dry mouth, fatigue

4. Carbonic Anhydrase Inhibitors

   • Topical: Dorzolamide
   • Oral: Acetazolamide
   • Mechanism: Inhibit enzyme carbonic anhydrase → reduces aqueous production
   • Side Effects: Metabolic acidosis, kidney stones (especially with oral form)

5. Miotics (Cholinergic Agonists)

   • Pilocarpine
   • Mechanism: Constricts pupil, opens trabecular meshwork → increases outflow
   • Clinical Use: Acute angle-closure glaucoma
   • Side Effects: Headache, blurred vision

6. Rho Kinase Inhibitors

   • Netarsudil
   • Mechanism: Increases trabecular outflow
   • Newer class with expanding clinical use

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