Glaucoma: Treatment & Drugs

The most common treatments for glaucoma are eye drops and, rarely, pills. Doctors use a number of different categories of eye drops to treat glaucoma. They either decrease the amount of fluid (aqueous humor) in the eye or improve its outward flow, and some do both. Sometimes doctors will prescribe a combination of eye drops.

People using these medications should be aware of their purpose and potential side effects, which a medical professional should explain. Some side effects can be serious. If you are concerned, call your doctor immediately. 

For more details about the side effects of these medications, please see our publication on Glaucoma Treatment Options.

Your doctor can decide which medications are best suited for you based on your individual case of glaucoma, medical history, and current medication regimen.

Types of Medications

Alpha Adrenergic Agonists

This medication both reduces aqueous humor production and increases its outflow. Allergic reactions frequently occur with this class of medication.

Examples include:

• Apraclonidine (Iopidine®)
• Brimonidine (Alphagan®)
• Epinephrine (Glaucon® and Epifrin®)
• Dipivefrin (Propine®)

Beta Blockers

This type of medication works to lower eye (intraocular) pressure by reducing aqueous humor production and decreasing the rate at which the fluid flows into the eye.

Examples include:

• Timolol (Timoptic XE Ocumeter® and Timoptic®)
• Levobunolol (Betagan®)
• Carteolol (Ocupress®)
• Metipranolol (OptiPranolol®)
• Betaxolol (Betoptic®)

Biodegradable Drug-delivery Implant

In March 2020, the FDA has approved Durysta™, a new long-term, biodegradable eye implant, containing bimatoprost (prostaglandin analog) to reduce eye pressure in people with ocular hypertension or open-angle glaucoma. Durysta is currently indicated as a single-use implant, and patients who receive thee implant would not be able to be re-administered a second time.

The most common side effect involving the eyes reported in patients using Durysta™ was eye redness. Other common side effects reported were: feeling like something is in your eye, eye pain, being sensitive to light, a blood spot on the white of your eye, dry eye, eye irritation, increased eye pressure, a loss of cells on the inner layer of the cornea, blurry vision, inflammation of the iris, and headache.

Carbonic Anhydrase Inhibitors

These are eye drops or pills that reduce fluid production in the eye. Examples include:

• Dorzolamide (Trusopt®)
• Brinzolamide (Azopt®)
• Acetazolamide (Diamox®): an oral medication
• Methazolamide (Neptazane®): an oral medication

Miotics

This type of medication is a cholinergic agent, which causes the pupil to become much smaller in diameter and helps increase fluid drainage from the eye. Examples include:

• Pilocarpine (Isopto Carpine®, Pilocar® and Pilopine HS® ointment)
• Echothiophate (Phospholine Iodide®)

Prostaglandin Analogs

This medication reduces eye pressure by increasing the outward flow of fluid from the eye. Examples include:

• Tafluprost ophthalmic solution (Zioptan™)
• Latanoprost (Xalatan®)
• Bimatoprost (Lumigan®)
• Travoprost (Travatan®)
• Unoprostone isopropyl ophthalmic solution (Rescula®)
• Latanoprostene bunod ophthalmic solution (Vyzulta™)

Rho Kinase Inhibitors

• Netarsudil ophthalmic solution (Rhopressa®)

Combinations

Combinations of eye drops may also be used to achieve better results. Examples include:

• Dorzolamide and timolol (Cosopt®)
• Latanoprost and timolol (Xalacom®)
• Brimonidine and timolol (Combigan™)
• Brinzolamide and brimonidine (Simbrinza®)
• Netarsudil and latanoprost (Rocklatan™)

Laser Therapies

Currently, laser surgery is the most frequently used procedure to treat glaucoma. It normally lowers eye pressure, but the length of time that pressure remains low depends on many factors, including:

• Age of the patient
• Type of glaucoma
• Other medical conditions that may be present

Many cases still need continued medication but possibly in lower amounts.

Your doctor may use laser surgery to treat open-angle, angle-closure, or neovascular glaucoma. He or she will perform laser surgery on an outpatient basis in the office or clinic after numbing your eye.

To reduce eye pressure, the doctor directs a laser toward the:

• Trabecular meshwork (tissue near the cornea and iris that drains the aqueous humor from the eye into the blood)
• Iris
• Ciliary body
• Retina

Types of laser surgery include:

Trabeculoplasty

The trabeculoplasty procedure is often used to treat open-angle glaucoma.

In argon laser trabeculoplasty (ALT), a high-energy laser is aimed at the trabecular meshwork to open areas in these clogged canals. These openings allow fluid to bypass drainage canals and flow out of the eye.

In selective laser trabeculoplasty (SLT) a low-energy laser treats specific cells in the trabecular meshwork. Because it affects only certain cells without causing collateral tissue damage, SLT can potentially be repeated.

Laser Peripheral Iridotomy

Laser peripheral iridotomy is frequently used to treat angle-closure glaucoma, in which the angle between the iris and the cornea is too small and blocks fluid flow out of the eye. A laser creates a small hole in the iris to allow fluid drainage.

Cyclophotocoagulation

Cyclophotocoagulation is usually used to treat more aggressive or advanced open-angle glaucoma that has not responded to other therapies. Your doctor directs a laser through the sclera or endoscopically at the eye fluid-producing ciliary body. The procedure helps decrease the production of fluid and lower eye pressure. Patients often need multiple treatments.

Scatter Panretinal Photocoagulation

This laser procedure destroys abnormal blood vessels in the retina that are associated with neovascular glaucoma.

The most common side effects of laser surgery are:

• Temporary eye irritation
• Blurred vision
• Small risk of developing cataracts

Surgery

Eye doctors often use conventional surgical procedures (also called incisional therapies) for glaucoma after other treatment strategies, such as medications and laser surgery, have failed.

When deciding on a treatment option, an ophthalmologist will take into account the unique aspects of each person's case, including the:

• Severity of the disease
• Response to medication
• Other health issues

Read more about the risks and benefits of glaucoma surgery.

Trabeculectomy

During a trabeculectomy, the ophthalmologist cuts a flap in the white part of the eye (sclera), removes a piece of trabecular meshwork (eye tissue located around the base of the cornea), and sutures the flap. This creates a new opening (a fluid bubble or bleb will form on the eye's exterior) through which the fluid (aqueous humor) flows and enters the bloodstream.

The surgery is normally an outpatient procedure but may require a one-night stay in a hospital. It is performed one eye at a time, usually four to six weeks apart.

Responses to this procedure vary:

• Many people are able to discontinue glaucoma medication afterward.
• However, in some cases, eye pressure may fall too low and/or the opening may heal over, causing pressure to rise again.
• There may also be continued changes to the optic nerve.
• Sometimes a second trabeculectomy must be performed.

Potential short-term side effects of this procedure include:

• Blurred vision
• Bleeding in the eye
• Infection.

Long-term effects may include worsened cataracts and the sensation of a foreign body in the eye. A buildup of fluid in the back of the eye may cause some shadows in vision.

For those who do not respond to trabeculectomy or are not candidates for this procedure, a glaucoma drainage implant may be placed in the eye. This tiny tube, inserted into the anterior chamber of the eye (between the cornea and the lens) facilitates the drainage of fluid.

An outpatient surgical procedure using a Trabectome™ is used for open-angle glaucoma. After the eye is numbed, the doctor uses a small instrument to create a tiny incision in the cornea and remove a piece of the trabecular meshwork to increase fluid drainage. No permanent hole or bleb is left on the eye. Trabectome surgery normally does not have the side effects associated with a trabeculectomy, although some bleeding may occur during the procedure.

Peripheral Iridectomy

Eye doctors use this procedure for angle-closure glaucoma. The doctor removes a small section of peripheral iris by incision, which allows fluid to drain more easily from the eye.

Canaloplasty and New Implant Devices

These devices and procedures are used to enhance the aqueous humor outflow to decrease eye pressure. They include:

• EX-PRESS Shunt, a subconjunctival filtration device
• Non-penetrating Ab Externo Schlemm's Canaloplasty
• Ab Interno Devices, including the Trabecular Micro-bypass Stent and the Trabectome
• Gold Microshunt, a suprachoroidal device

Glaucoma Surgery for Infants

Goniotomy is used almost exclusively for infants with congenital glaucoma. In this procedure, the doctor inserts a tiny blade through the cornea to cut the trabecular meshwork. This procedure allows the eye fluid to flow normally out of the eye.

Trabeculotomy is also used for infants with congenital glaucoma. The doctor makes an incision in the outer portion of the eye and uses a tiny probe to break through the trabecular meshwork. Eye fluid is then able to drain out of the eye, keeping eye pressure in a more normal range.

Potential Treatments for Glaucoma

Researchers are investigating many potential treatments for glaucoma and testing them in human clinical trials. For snapshots of clinical trials, explore Antidote, a search engine that can find a trial that’s right for you.