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Common glaucoma medications

woman applying eye drops

Glaucoma medications, which are usually administered as eye drops or orally in pill form, are used to manage the fluid pressure inside the eye, also called intraocular pressure, or IOP. Successfully maintaining normal eye pressure over a patient’s lifetime ensures a healthier vision outlook.

The number of treatment options for glaucoma can feel overwhelming at first. Each class of glaucoma medication acts in a slightly different way, each affecting different parts of the vision system.

As with many other conditions, however, glaucoma medications can have different side effects for each patient. The key to finding a successful glaucoma treatment plan is working with an eye doctor to find a medication (or combination of medications) that provides the best results with the most manageable side effects.

Thankfully, ophthalmologists and other eye specialists are thoroughly trained to help you explore every option and guide you down a customized treatment path.

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Eye drops for glaucoma

Prescription eye drops are the most common treatment method prescribed by eye doctors to normalize eye pressure.

Glaucoma eye drops are classified by the active ingredient that makes each drug work. Most of the options listed below are available in both generic and name-brand forms through your local pharmacy.

Prostaglandins

Prostaglandin eye drops only need to be used once per day, making them easier for patients to remember. Also called prostaglandin analogs, these drops reduce fluid pressure by relaxing tiny muscles inside the eye, allowing a better outflow of fluids.

Beta blockers

Beta blocker eye drops decrease fluid production in the eyes. They’re commonly prescribed alongside prostaglandin drops, when necessary.

Medications that enter through the eyes as eye drops will partially absorb into the bloodstream, potentially affecting unrelated body systems. There are certain medical history factors an eye doctor will consider if he or she is considering beta blockers, specifically any preexisting heart, lung, diabetes or mental health conditions. 

Alpha-adrenergic agonists

These drugs decrease the rate that aqueous humor — the fluid inside the eye — is produced. They can be used alone or in combination with other glaucoma-treating eye drops.

Carbonic anhydrase inhibitors

Like alpha-adrenergic agonists, these eye drops decrease the rate of aqueous humor fluid production. They’re usually used in combination with other eye drops used to treat glaucoma.

This type of drug is also available in oral pill form. Many people don’t tolerate the oral form well due to its whole-body side effects. These can include fatigue, depression, loss of appetite, weight loss, loss of libido, kidney stones, metallic taste and peripheral neuropathy, characterized by a tingling sensation in the fingers and toes.

Epinephrine

Epinephrine eye drops have a dual effect on the eye. They decrease the rate of aqueous humor fluid production in the eye and simultaneously increase the outflow of the same fluid.

Combination glaucoma eye drops

Many glaucoma patients require more than one type of medication to normalize their eye pressure. 

Pharmaceutical companies have produced certain “combination” eye drops that include two different glaucoma medications in the same bottle. Your doctor may prescribe one of these combination drops for convenience.

SEE RELATED: Natural remedies for glaucoma

Emergency glaucoma medications

Some medications are geared toward a type of glaucoma that occurs over a short period of time, often called narrow-angle or acute-angle glaucoma. This can also occur after a traumatic eye injury.

Glaucoma that comes on suddenly requires immediate treatment to avoid vision loss. When surgery can be avoided, an eye doctor could use one of the following medications:

Parasympathomimetics

These drugs work by increasing how much aqueous humor fluid flows out of the eye, especially in the case of narrow-angle glaucoma. Parasympathomimetic eye drops cause the pupil to get smaller, which helps open up the narrowed or blocked drainage area in the eye.

Hyperosmotic agents

Hyperosmotic agents reduce eye pressure by reducing the amount of fluid inside the eye. These drugs are usually reserved for severely high eye pressure that requires immediate treatment to avoid optic nerve damage. 

There are oral and intravenous hyperosmotic drugs, which are usually only administered on a one-time, emergency basis.

SEE RELATED: Glaucoma glasses can help manage symptoms

Can marijuana or CBD treat glaucoma?

Now that medicinal and recreational use of marijuana is being legalized in more U.S. states, its medical benefits are being touted more than ever before. 

The treatment of glaucoma has long been rumored as one of the health benefits of certain cannabinoids — ingredients in marijuana and other cannabis products.

So, does marijuana really treat glaucoma?

Technically, yes. Functionally, not so much — at least for the time being.

While the psychoactive part of marijuana, THC, has been shown to significantly lower eye pressure, its effect is considered too temporary and debilitating to be a viable treatment. 

The American Academy of Ophthalmology notes that marijuana would need to be ingested six to eight times every single day since glaucoma requires a constant normalization of eye pressure.

Marijuana’s more widely available and accepted relative, CBD (cannabidiol), is also marketed as having numerous health benefits, although many have yet to be proven, according to the U.S. Food & Drug Administration (FDA).

As a glaucoma treatment, one study of CBD eye drops on mice showed the chemical actually caused eye pressure to increase by 18%.

While it’s unlikely CBD will ever be used medically to treat glaucoma, the current limitations of cannabinoids like THC aren’t stopping biotech companies from researching longer-lasting solutions. It’s entirely possible that, one day, a cannabis-based treatment for glaucoma will be readily available.

SEE RELATED: Glaucoma and marijuana: Treatment risks and benefits

New glaucoma treatments and continuing research

The medical and pharmaceutical industries are always on the search for new ways to improve upon the current treatments of glaucoma.

An example is the drug Rocklatan, a combination eye-drop medication that was recently approved by the FDA for use with open-angle glaucoma. One of its ingredients specifically targets part of the eye fluid drainage process called the trabecular meshwork, believed in many cases to be the main culprit behind poor drainage.

Another drug called Rhopressa was approved shortly before Rocklatan and also targets the trabecular meshwork in a once-daily eye drop.

With each passing year, new and emerging glaucoma drugs like Rocklatan and Rhopressa will continue to let eye doctors form more individualized treatment plans around each of their patient’s needs.

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