Glaucoma—2: Treatment

Prostaglandin analogues Prostaglandin analogues (such as, latanoprost, travoprost, and bimatoprost) reduce the intraocular pressure by increasing aqueous outflow from the eye through the uveoscleral pathway. Pilocarpine is usually given four times a day but can be used twice daily in a combined form with a β blocker or once at night in a gel preparation, which reduces side effects. * A newer generation of drugs that stimulate the α receptors of the sympathetic system is now used-for example, brimonidine (used twice a day) or apraclonidine * Contraindications include cardiovascular disease because of the potential systemic sympathomimetic effects * Topical adrenaline is now rarely used because it is less effective than β blockers and has adverse effects on the conjunctiva Carbonic anhydrase inhibitors These are available as topical (for example, dorzolamide, brinzolamide) or oral (for example, acetazolamide) drugs. International Glaucoma Association King's College Hospital Denmark Hill, London SE5 9RS Tel/fax: 020 7737 3265 Email: iga@kcl.ac.uk - Guidelines for managing glaucoma are available from the European Glaucoma Society ( www.eugs.org/ )and the American Academy of Ophthalmology ( www.aao.org/news/eyenet/ ) The ABC of Eyes is by P T Khaw, professor of ophthalmology at Moorfields Eye Hospital, London ( p.khaw@ucl.ac.uk , P Shah, consultant ophthalmic surgeon at Birmingham and Midland Eye Centre, Birmingham ( p.f.shah@talk21.com ), and A R Elkington, emeritus professor of ophthalmology, University of Southampton.