Medical management: Eye drops
Medications to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogues, beta blockers, alpha agonists, and carbonic anhydrase inhibitors. In addition, combination drugs/drops are available for patients who require more than one type of medication. Eye drops used in treating glaucomadecreases pressure in the eye by either increasing the drainage of fluid out of the eye or to by decreasing the formation of fluid in the eye in the first place or by both mechanisms.
Various types of Glaucoma drops are as follows:
Prostaglandin analogues (Decreases pressure in the eye by increasing drainage of fluid from the eye): They are the most commonly used anti-glaucoma preparation currently used. They are quite user frindley as only one drop is needed per eye per day and have the least number of side effects. The common preparations in this group are: Latanoprost(Xalatan), Monoprost (Preservative free Latanoprost), Bimatroprost (Lumigan, including preservative free preparation), Travaprost (Travatan), Tafluprost (Saflutan, preservative free drop).
Contraindications: Pregnancy, allergy
Common Side Effects: Brown pigmentation of iris, Increased length of eye lashes, red eyes (mostly transient).
Beta blockers (Decrease pressure in the eye by decreasing fluid formation in the eye): They used to be the most commonly used anti-glaucoma drops before prostaglandin analogues came into use. Now a days they are the second most commonly used group of anti-glaucoma drops. This group comprises drops like: Timoptol (Timolol 0.5%, preserved or preservative free and used twice daily), Timoptol LA(Long acting) 0.25% used once daily, Gel Tiopex 0.1%(preservative free and used once daily) and Betaxolol (Betoptic 0.5%, used twice daily). You are advised not to take this as the last thing before bed as this group of drops can reduce blood pressure which may compromise blood flow to the optic nerve leading to faster progression and worsening of glaucoma.
Contraindications: Asthma, COPD, shortness of breath, airway and lung diseases, congestive heart failure, heart block and low heart rate (Bradycardia).
Side effects: Dry eyes, allergy, fatigue, shortness of breath, decreased heart rate, decreased blood pressure, depression, loss of libido.
Carbonic anhydrase inhibitors ( Decreases pressure in the eye by decreasing fluid formation in the eye). The medication in this group are: Dorzolamide (Trusopt 2%, preserved or preservative free, used 2-3 times daily), Brinzolamide (Azopt 1%, used 2-3 times daily) and Tablet. Acetazolamide (Diamox 250mg tablet, used 1-4 times daily). The tablet Diamox is usually meant for a short duration due to its side effect profile.
Contraindications: Kidney diseses, allergy. Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis. It is contraindicated in patients with cirrhosis because of the risk of development of hepatic encephalopathy.
Side effects: Allergy, pins and needles (tingling sensation) on finger tips and toes, lethargy, decreased appetite, stinging sensation, depression, increased frequency of urination. Caution is advised for patients receiving concomitant high-dose aspirin and Diamox, as anorexia, tachypnea, lethargy, metabolic acidosis, coma, and death have been reported.
WARNING
Fatalities have occurred, although rarely, due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, anaphylaxis, agranulocytosis, aplastic anemia, and other blood dyscrasias. Sensitizations may recur when a sulfonamide is readministered irrespective of the route of administration. If signs of hypersensitivity or other serious reactions occur, discontinue use of this drug and get seen to by your GP/A&E.
Alpha agonists ( Decreases eye pressure by dual mechanisms of increasing outflow and reduction of fluid formation in the eye). This group comprises Brimonidine (Alphagan/Alphagan P, 0.1-0.15%, used 2-3 times daily), Apraclonidine (Iopidine, 0.5% or 1% used 3 times daily).
Contraindications: Allergy
Side effects: Burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction.
GENERAL INSTRUCTIONS ABOUT MEDICATIONS
1. Please read information/instruction leaflet carefully
2. Avoid if you are allergic to it
3. Store it as instructed in the information leaflet, avoid direct sunlight
4. Discard after 4 weeks of opening the bottle
5. Wash your hands before application of drops
6. Glaucoma is a blinding disease, please use your drops regularly and as instructed without fail.
7. You must continue with drops unless changed or stopped by your doctor
8. You will get a month's supply from the hospital at the beginning, please go to your GP for all susequent and timely represcription.
9. Please discuss with your doctor/GP any concern you have about interaction of your various medications if you are taking more than one.
10. Please take your medications on a set time and keep a diary if possible.
11. Please carry your prescription & details of your medicines/drops every time you visit any doctor.
Contact lenses
Caution:
For those who usually wear contact lenses and have been prescribed eye drops, you may need to stop wearing your contact lenses and wear glasses instead. This is because medication in the eye drops can build up in the contact lenses and may cause toxicity and harm your eyes. One way around this may be to use your eye drops about an hour before putting on your contact lenses and after half an hour after removing your contact lenses. Please discuss your circumstances with Mr Raj or his team.
Information Video:
http://www.youtube.com/watch?v=X9NgArAMAQ8
Medications to treat glaucoma are classified by their active ingredient. These include: prostaglandin analogues, beta blockers, alpha agonists, and carbonic anhydrase inhibitors. In addition, combination drugs/drops are available for patients who require more than one type of medication. Eye drops used in treating glaucoma decreases pressure in the eye by either increasing the drainage of fluid out of the eye or to by decreasing the formation of fluid in the eye in the first place or by both mechanisms.
Various types of Glaucoma drops are as follows:
Prostaglandin analogues (Decreases pressure in the eye by increasing drainage of fluid from the eye): They are the most commonly used anti-glaucoma preparation currently used. They are quite user frindley as only one drop is needed per eye per day and have the least number of side effects. The common preparations in this group are: Latanoprost(Xalatan), Monoprost (Preservative free Latanoprost), Bimatroprost (Lumigan, including preservative free preparation), Travaprost (Travatan), Tafluprost (Saflutan, preservative free drop).
Contraindications: Pregnancy, allergy
Common Side Effects: Brown pigmentation of iris, Increased length of eye lashes, red eyes (mostly transient).
Beta blockers (Decrease pressure in the eye by decreasing fluid formation in the eye): They used to be the most commonly used anti-glaucoma drops before prostaglandin analogues came into use. Now a days they are the second most commonly used group of anti-glaucoma drops. This group comprises drops like: Timoptol (Timolol 0.5%, preserved or preservative free and used twice daily), Timoptol LA(Long acting) 0.25% used once daily, Gel Tiopex 0.1%(preservative free and used once daily) and Betaxolol (Betoptic 0.5%, used twice daily). You are advised not to take this as the last thing before bed as this group of drops can reduce blood pressure which may compromise blood flow to the optic nerve leading to faster progression and worsening of glaucoma.
Contraindications: Asthma, COPD, shortness of breath, airway and lung diseases, congestive heart failure, heart block and low heart rate (Bradycardia).
Side effects: Dry eyes, allergy, fatigue, shortness of breath, decreased heart rate, decreased blood pressure, depression, loss of libido.
Carbonic anhydrase inhibitors ( Decreases pressure in the eye by decreasing fluid formation in the eye). The medication in this group are: Dorzolamide (Trusopt 2%, preserved or preservative free, used 2-3 times daily), Brinzolamide (Azopt 1%, used 2-3 times daily) and Tablet. Acetazolamide (Diamox 250mg tablet, used 1-4 times daily). The tablet Diamox is usually meant for a short duration due to its side effect profile.
Contraindications: Kidney diseses, allergy. Acetazolamide therapy is contraindicated in situations in which sodium and/or potassium blood serum levels are depressed, in cases of marked kidney and liver disease or dysfunction, in suprarenal gland failure, and in hyperchloremic acidosis. It is contraindicated in patients with cirrhosis because of the risk of development of hepatic encephalopathy.
Side effects: Allergy, pins and needles (tingling sensation) on finger tips and toes, lethargy, decreased appetite, stinging sensation, depression, increased frequency of urination. Caution is advised for patients receiving concomitant high-dose aspirin and Diamox, as anorexia, tachypnea, lethargy, metabolic acidosis, coma, and death have been reported.
WARNING
Fatalities have occurred, although rarely, due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, anaphylaxis, agranulocytosis, aplastic anemia, and other blood dyscrasias. Sensitizations may recur when a sulfonamide is readministered irrespective of the route of administration. If signs of hypersensitivity or other serious reactions occur, discontinue use of this drug and get seen to by your GP/A&E.
Alpha agonists ( Decreases eye pressure by dual mechanisms of increasing outflow and reduction of fluid formation in the eye). This group comprises Brimonidine (Alphagan/Alphagan P, 0.1-0.15%, used 2-3 times daily), Apraclonidine (Iopidine, 0.5% or 1% used 3 times daily).
Contraindications: Allergy
Side effects: Burning or stinging, fatigue, headache, drowsiness, dry mouth and nose, relatively higher likelihood of allergic reaction.
GENERAL INSTRUCTIONS ABOUT MEDICATIONS
1. Please read information/instruction leaflet carefully
2. Avoid if you are allergic to it
3. Store it as instructed in the information leaflet, avoid direct sunlight
4. Discard after 4 weeks of opening the bottle
5. Wash your hands before application of drops
6. Glaucoma is a blinding disease, please use your drops regularly and as instructed without fail.
7. You must continue with drops unless changed or stopped by your doctor
8. You will get a month's supply from the hospital at the beginning, please go to your GP for all susequent and timely represcription.
9. Please discuss with your doctor/GP any concern you have about interaction of your various medications if you are taking more than one.
10. Please take your medications on a set time and keep a diary if possible.
11. Please carry your prescription & details of your medicines/drops every time you visit any doctor.
Contact lenses
Caution:
For those who usually wear contact lenses and have been prescribed eye drops, you may need to stop wearing your contact lenses and wear glasses instead. This is because medication in the eye drops can build up in the contact lenses and may cause toxicity and harm your eyes. One way around this may be to use your eye drops about an hour before putting on your contact lenses and after half an hour after removing your contact lenses. Please discuss your circumstances with Mr Raj or his team.
Information Video:
http://www.youtube.com/watch?v=X9NgArAMAQ8
Private & NHS patients
How to see Mr Raj
For private patients & referrals
Mr Akash Raj
Consultant Ophthalmologist, Glaucoma specialist & Cataract surgeon
Stourside Hospital (part of West midland Hospital)
60 Bradley Road
Stourbridge
DY8 1UX
01384 505 183
(Alternate:
Monday Evenings)
Appointments:
01384 912966
Private Secretary: Tara Ralph : 01384 632 636
Mr Akash Raj
Consultant Ophthalmologist, Glaucoma & Cataract specialist.
For NHS Referrals through GP/Opticians
Mr Akash Raj
Consultant Ophthalmologist (Glaucoma Lead)
Pensnett Road
Dudley
West Midlands
DY1 2HQ
Phone: 01384456111
Extn. 5815 (NHS Secretary: Lyn Eaton)
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