Glaucoma & Medications

Glaucoma Therapy – Stockton, Modesto, Tracy, Manteca, Merced

There are many medications that play a role in the health of ones eyes. There are medications that are used to treat glaucoma and there are medications that are contraindicated. Some of the basics will be presented on this page. It is essential to understand that this page is for information only and only you and your doctor can make a decision about your care.

Glaucoma Medications

Glaucoma medications have the aim of lowering the pressure inside the eye (the intraocular pressure). There are different classes and categories of medications. They will be briefly reviewed here.It is essential to understand that these medication do not improve your vision... they only help you retain your current vision.

Prostaglandin Analogs (Aqua-Green Bottle Caps)

Prostaglandins like Lumigan, Xalatan and Travatan have an Aqua-Green bottle tops

There are 3 main prostaglandin drugs namely Xalatan, Travatan, and Lumigan. These drugs lower the intraocular pressure by decreasing the increasing the drainage of the fluid outside the eye. They tend to be the most potent drugs and many times are used as the first-line agent because of the potency and the ease of once daily use. They can cause the eyes to be red, irritated, and irritated. They can cause the growth of lashes and discoloration of iris and eyelid skin. These side effects are generally minimal and many times are accepted given the greater goal of retaining vision.


Beta-Adrenergic Antagonists – Beta Blockers (Yellow Bottle Caps)

A large variety of beta-blockers are available, generic and commercial brands.  They all have yellow topsTimolol is the most commonly used drug in this category. These medications cause reduction in the production of fluid inside the eye, thereby causing a reduction of the intraocular pressure. These drops tend to be used either as a first-line or as a second-line agents. This category has a well proven track record and is readily available in generic brand. Typically it is used twice daily. Caution should be used when used in patients with asthma or bronchospasm and in patients with slow heart rate. The effectiveness of these medications may be reduced with prolonged use (years).


Alpha-2 Adrenergic Agonists (Purple Bottle Caps)

Alpha-2 Agonists have purple tops


The most commonly used drug in this category is Alphagan (brimonidine). These medication cause reduction in the production of fluid inside the eye, thereby causing a reduction of the intraocular pressure. These drops tend to be used as a second-line agents. This category is also available in generic and typically it is used twice daily even though FDA approval tends to be three times daily.



Carbonic Anhydrase Inhibitor (Orange Bottle Caps)

Carbonic Anhydrase Inhibitors have an orange bottle top


Trusopt (dorzolamide) and Azopt (brinzolamide) are the most commonly used drops in this category. There are also pills available in this category such as acetazolamide (Diamox) and methazolamide (Neptazane). Drops are much preferred as they don't carry as much systemic side effects as the pills. These drops tend to be considered as a third line agent. Their effect is modest.



Cholinergic Agonists (Green Bottle Caps)

Pilocarpine has a green top


Pilocarpine is the most commonly available drug in this category. They cause reduction of the intraocular pressure by increasing drainage of fluid outside of the eye. They are now considered as a fourth-line agents. They cause strong ciliary muscle and pupillary constriction leading to a significant reduction in the amount of light that enters the eye and thereby loss of brightness of vision. Most patients do not like this effect. An increase in the risk of retinal detachment is also noted. Depending on the type of glaucoma, if there is a narrow component, pilocarpine could be a good adjunct.


Combined Drops

Combined meds like Cosopt and Combigan have very dark blue tops


Cosopt and Combigan are mixed drops. Cosopt is a combination of timolol and dorzolamide. Combigan is a combination of timolol and brimonidine. These medication make the treatment of glaucoma much more convenient, when multiple drops are used.





Many times you read the warning label of your medications and it states if you have glaucoma, consult your doctor. Many drugs may have an effect on the anterior segment of the eye and cause narrowing of the drainage angle of the eye and cause a rise in the pressure of the eye, or even a frank acute angle closure glaucoma attack. It is very important to remember that this warning does not apply to the vast majority of patients under treatment for glaucoma. The open angle glaucoma tends not to be affected by these medications. If you have had cataract surgery of both eyes, again this warning likely does not apply to you either. These warnings apply to patients with anatomically narrow angles and narrow angle glaucoma.

Many medications such as antihistamines like Benadryl and as presented below Topomax can have profound effect in some patients.

Case presentation

Visante image of an eye with narrow angles due to Topomax

A 30-year-old white female taking Topamax (topiramate; Ortho-McNeil-Janssen Pharmaceuticals, Inc., Titusville, NJ) for migraines for 2 weeks presented with progressively declining vision that had reached 20/400. Her refractions were -3.50 D in the right eye and -5.00 D in the left (both correctable to 20/20). The Visante OCT showed that the anterior chambers in both eyes were relatively shallow and that the angles were approximately 25º (Figure above). Patient was asked to discontinue the Topamax.

At 2 weeks, her vision had returned to 20/20 uncorrected with slight hyperopia. The Visante showed an obvious dynamic change internally. The anterior chamber had deepened from an endothelial-anterior lens capsule distance of 2.26 to 2.79 mm. The gonio angles also opened up from 25º to 43º. Notable changes in the crystalline lens rise were also seen, with a reduction from 900 μm to 520 μm (Figure below).

Visante image of an eye with narrow angles due to Topomax now normal off topomax

Page last edited on 08/23/09

In addition to helping Northern California glaucoma patients improve their eye health, Dr. Ash specializes in state-of-the-art cataracts and laser eye surgery treatments. At his laser eye surgery Modesto / Stockton offices, patients are offered several laser eye surgery options, including traditional LASIK and iLASIK. Dr. Ash also performs several highly effective cataracts treatments, including premium IOLs cataract surgery in Stockton / Modesto.

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