Antiglaucoma

Antiglaucoma refers to medications and procedures used to lower intraocular pressure (IOP) in order to prevent damage to the optic nerve from glaucoma and related conditions such as ocular hypertension.

Most agents act by reducing aqueous humor production, increasing outflow, or both. The main drug classes include prostaglandin analogs (e.g., latanoprost, bimatoprost, travoprost) which increase uveoscleral outflow; beta blockers (e.g., timolol, betaxolol) which reduce production; alpha-adrenergic agonists (e.g., brimonidine, apraclonidine) which decrease production and can modestly improve outflow; carbonic anhydrase inhibitors (e.g., dorzolamide, brinzolamide; acetazolamide when systemic) which lower production; cholinergic agents (e.g., pilocarpine) which enhance trabecular outflow; and rho kinase inhibitors (e.g., netarsudil) which increase outflow and may reduce IOP.

Administration is typically as topical eye drops, often once or twice daily; fixed-dose combinations are common to reduce dosing burden. Some patients may require oral acetazolamide in acute or resistant cases or in certain systemic conditions; adherence and tolerability influence choice.

Nonpharmacologic options include laser therapy such as selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT), and surgical approaches such as trabeculectomy or glaucoma drainage devices, including minimally invasive glaucoma surgery (MIGS).

Side effects vary by agent and can include conjunctival hyperemia, dry eye, blurred vision, and systemic effects like hypotension, bradycardia, or electrolyte disturbances; certain agents are avoided in asthma, COPD, heart block, or pregnancy.

Management goals are to achieve a target IOP that reduces risk of progression; treatment plans consider glaucoma type, severity, comorbidities, and patient preferences; regular monitoring of IOP, optic nerve head, and visual fields is essential.