Glaucoma

Glaucoma Eye Drops

There are several options for lowering eye pressure, and eye drops are one choice of treatment. As a non-surgical form of treatment, eye drops can safely lower eye pressure for years. These are applied on a daily or twice daily basis. Sometimes, more than one drop is required to lower the eye pressure. 

As a newly diagnosed person with glaucoma, you may have been told that your intraocular eye pressure is high. High intraocular eye pressure is when the fluid in your eye is not draining at an optimal or safe rate, leading to glaucoma; a condition that results in vision loss. Eye drops are an effective method for controlling glaucoma by encouraging the fluid in the eye to drain successfully and in turn lower both eye pressure and the progression of the glaucoma disease.

Dr Skalicky will direct you on how to use your eye drops correctly – missing or omitting doses can lead to incomplete and inadequate treatment.

PRESERVATIVE-FREE GLAUCOMA MEDICATIONS

Eye drops come in two forms of packaging:

a. Bottles that have enough drops to last 1 month;
b. Tiny dispensers (“minims”) that are used 1-2 times then discarded.

The month-long bottles can be easier and more convenient to use, but contain preservatives that may be irritating to your eyes. Rarely people can develop an allergy to preservatives in medications If this is the case, preservative-free glaucoma medications can be used to reduce the eye pressure.

Typical eye drop bottle with preservatives

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Eye drop minims – preservative free medications

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TYPES OF PRESSURE-LOWERING EYE DROPS:

Prostaglandin analogues (latanoprost, travoprost, bimatoprost, tafluprost)

Prostaglandin analogues lower eye pressure by encouraging drainage through an alternative pathway (the uveoscleral route) from the eye. These are administered once daily.

Side effects: They are generally well tolerated, but some negative reactions include red, itchy eyes or exacerbate symptoms of dry eye. They may darken the eye colour or skin around the eye and lengthen eyelashes.

Beta-blockers (timolol, betaxolol)

Beta-blockers lower eye pressure by reducing the production of fluid in the eye. They are administered twice daily.

Side effects: They are generally well tolerated but may cause red, sore eyes and may also be absorbed into the blood stream and affect other parts of the body, notably the lungs, heart and blood vessels. They can cause a range of symptoms, including breathlessness, reduced exercise tolerance, nightmares and impotence. They should be avoided in patients with asthma, low blood pressure and abnormalities of the heart beat.

Carbonic anhydrase inhibitors (dorzolamide, brinzolamide)

Carbonic anhydrase inhibitors lower eye pressure by reducing the production of fluid in the eye. They are administered twice or three times daily.

Side effects: They can cause stinging of the eyes and red, sore eyelids. Rarely they can lead to a severe allergy affecting the skin and whole body.

Alpha-2 agonists (brimonidine, apraclonidine)

Alpha-2 agonists reduce eye pressure by reducing fluid production and increasing drainage from the eye.

Side effects: Negative reactions can include red, irritated eyes. Alpha-2 agonists have a slightly greater risk of allergy and tachyphylaxis (adverse effects of the drop reduces over time) than the other types of drops. Brimonidine should be avoided in children.

Miotics (Pilocarpine)

Miotics are used to treat some forms of glaucoma (eg narrow angle glaucoma). They work by constricting the pupil and widening the drainage angle of the eye.

Side effects: Miotics can result in dimmed vision and eye or brow ache.

Combination drops

Sometimes more than one glaucoma medication is required; for this reason, combination bottles (2 eye drop types mixed within one bottle) are available.

How to administer eye drops:

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 1. Wash your hands.
 2. Tilt your head back as far as you can, or lie down.
 3. Gently pull down the lower lid and look up.
 4. Lightly squeeze the bottle until a drop lands inside your lower eyelid. (You may find it easier to rest the bottle on the bridge of your nose. Avoid touching your eye with the tip of the bottle). 

 

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5. Use a clean tissue to gently dab away the excess drops.
6. After the drop, close your eye and place a finger on the inner corner of the eye for 1 minute to prevent the drop flowing down the tear sac.

Accreditations & Credentials

Dr Skalicky is an active clinician, surgeon, researcher, teacher, academic and health advocate who has published over 40 articles in international Ophthalmology journals. Known as an Ophthalmologist ahead of the times, Dr Skalicky’s career highlights are exceptional and atypical for his age.