This presentation describes all clinical aspects of glaucoma medications.....you can watch this presentation in video form at the following link https://www.youtube.com/watch?v=92xurWP41dA

1. Glaucoma
Medications
BY
Dr. Amr Mounir
Lecturer of Ophthalmology
Sohag University

2. Background
The aqueous humor is a transparent watery fluid
It fills both the anterior and the posterior chambers of the eye
Aqueous humor is produced by the ciliary processes
The drainage route for aqueous humor flow occurs
through two routes
1) Main route: Trabecular meshwork 90%
2) Secondary route: Uveoscleral drainage 10%

3. Background
α1-, α2-, β1- and β2-adrenoceptors have been located in the ciliary body.
α2- and β2-Adrenoceptors have also been located in the trabecular meshwork
- Stimulation of α2-adrenoceptors in the ciliary body,
the aqueous flow can be reduced,
while the agonist effect on the β2-adrenoceptors is
an increase in flow.
- Carbonic anhydrase isoenzyme II is found in
the ciliary body epithelium and stimulates aqueous
production

4. Anti glaucoma drugs classification
DRUGS THAT INCREASE AQUEOUS
OUTFLOW
DRUGS THAT REDUCE AQUEOUS
HUMOUR PRODUCTION
Nonspecific Adrenergic Agonists
:epinephrine, dipivefrin
Beta-Blockers : levobunolol, timolol, carteolol,
betaxolol
Parasympathomimetics : pilocarpine,
carbachol,
echothiophate
Alpha-2 Adrenergic Agonists : apraclonidine,
brimonidine
Prostaglandin Analogues : latanoprostCarbonic Anhydrase Inhibitors
:acetazolamide, dorzolamide

5. Beta-Blockers
1st line therapy for all types of glaucoma
• Good efficacy
• Minimal S/E
Mechanism of action:
Decreases aqueous humor production by blocking
beta2 receptors on ciliary epithelium

6. TIMOLOL:
• Most widely used ocular Antiglaucoma
• Due to its non selective beta action
Contraindicated in COPD, asthma & heart failure
• Available as 0.5 % solution & gel
S/E:-
• Systemic: Irregular heart rhythm, angina and bronchospasm
• Local:- superficial punctate keratitis, corneal
anesthesia

7. LEVOBUNOLOL
Levobunolol HCL Drops : Available as 0.5 – 1% solution
S/E:- the same as Timolol
BETAXOLOL
Topical β1 blocker used in
glaucoma
• lesser efficacy in reducing IOP compared to Timolol
• Additional neuroprotective effect.

8. CARBONIC ANHYDRASE INHIBITORS
2 types
Systemic CA inhibitors:-
Acetazolamide, Methazolamide
Topical CA inhibitors:-
Dorzolamide, Brinzolamide
Mechanism:-
• Blocks CA enzyme reversibly in ciliary body – reduces
aqueous humor production

9. SYSTEMIC CARBONIC ANHYDRASE
INHIBITORS
DOSAGE:-
Acetazolamide 125mg, 250mg
SIDE EFFECTS:-
High risk of systemic side effects.
Paraesthesias, Kidney stones, aplastic anemia,
Depression, Hypokalemia

10. TOPICAL CARBONIC ANHYDRASE
INHIBITOR
DORZOLAMIDE:-
• 1st topical CA inhibitor used
• Advantage – not absorbed systemically
• Available as 2 % solution
- local S/E includes corneal edema, allergic reaction,
burning & stinging sensation
BRINZOLAMIDE
• Available as 1% solution
• Better tolerated than dorzolamide – its pH is 7.4

11. PROSTAGLANDIN ANALOGUES
They include latanoprost, unoprostone,
bimatoprost, travoprost.
Mechanism:-
Decreases IOP by increasing uveoscleral
outflow

12. PROSTAGLANDIN ANALOGUES
LATANOPROST
• An analogue of PGF2α
• Available as 0.0005% solution, administrated at evening
• Requires refrigeration & protection from sunlight
S/E: – Conjunctival hyperemia , Iris
pigmentation, cystoid macular edema,
changes in eyelash number/color/length/thickness

13. BIMATOPROST:
• A synthetic prostamide analogue, administrated at evening
• Available as 0.03% solution
• Does not require refrigeration
TRAVAPROST:
• Synthetic PGF2α analogue, administrated at evening
• Available as 0.004% solution,
• Does not require refrigeration/ protection from
sunlight

14. ADRENERGIC AGONISTS
Includes:
• Non selective – epinephrine & dipivefrin
• Selective alpha2 agonists- Apraclonidine, Brimonidine
ALPHA2 AGONISTS:
Mechanism: Decrease aqueous humor production
APRACLONIDINE:
• Available as 0.5 – 1 %
• Short term use – Post op rise in IOP & adjuvant in
POAG

15. ADRENERGIC AGONISTS
BRIMONIDINE:
30 times more selective α2 agonist than Apraclonidine
Neuroprotective effect
Available as 0.2 - 0.5% ,
Uses:
- In patients with contraindications to beta
blockers,
-Short term use in post op raise in IOP

16. CHOLINERGIC AGONISTS
Most commonly used : Pilocarpine eye drops, gel
Mechanism:
Causes contraction of
longitudinal ciliary muscle →
trabecular outflow
Available as 0.5 to 10 % eye drops
Main indication in PACG
Side effects: Superficial punctate keratitis ,
induced myopia, increased risk of retinal
detachment & iritis

17. Thank you
“Alshadouf”
Mahmoud Said
1897-1964