• how to use eye drops
• in brief
• allergies
• in detail
  • timolol & timoptol
  • teoptic/Cartelol
  • betoptic
  • Trusopt
  • Cosopt
  • Azopt
  • propine
  • pilocarpine
  • Xalatan
  • travaprost (Travatan)
  • bimatoprost (Lumigan)
  • Ganfort
  • Xalacom
  • Alphagan
• diamox (tablets)
• Useful drop regimes 
• Drops in pregnancy                                          

Glaucoma pages

What is glaucoma? Internat. Glaucoma Association Intraocular hypertension Low tension glaucoma Angle closure glaucoma & narrow angle glaucoma / laser iridotomies Visual field testing Animation of glaucoma Drops & tablets for glaucoma Animation of laser iridotomy Animation of trabeculectomy Progression model Rubeotic glaucoma Rubeotic glaucoma animation for professionals for students Case 1  2  3  4  5  6  7  8 Mito Trab for professionals 4mb Corneal thickness & IOP trabeculectomy notes Glaucoma letters Glaucoma for professionals

This is very well described here . A word document for patients.

• only one drop per eye is needed each time
• one of the easist ways...lie down or put you head back
• pull the lower eyelid down
• instil the drop by dropping it on the open eye...you will feel it go in
• press on the tear duct for 2 minutes after using the drop
• leave 10 minutes between different types of drops

Research has shown only 2 out of 3 people use their glaucoma drops regularly. Please be honest and tell the doctor if you do not use the drops, or only use them occasionally.

When a doctor recommends a eye drop or drug he has to balance the benefits versus the disadvantages for that particular patient. No drop is suitable for everyone.... different drops (or drugs) suite different people.

Generally, any drop or drug causing major problems or side effects should be stopped. Stop beta-blocker drops if you get asthma, for instance. Stop the drops if your eyes become very sore and red. Other major side effects are listed below for most of the glaucoma drops.

There may or may not be treatment that is perfect for you, and if you have already had major problems with one drop, it may be recommended that you put up with minor side effects such as slightly sore eyes with your current drop.

For some people, such as those with advanced glaucoma or high pressure, the drops are crucial if you want to keep your sight. (For some people, such as very mild glaucoma in a person aged 85 years or with severe heart problems, they may not be essential: ask your ophthalmologist.)

Someone with advancing glaucoma, or a person expecting to live 20 years with a highish pressure (other factors also need to be taken into account), may need more than one drop. The drops have an additive effect, although the first drop used always has the most effect, and the third the least. Different drops lower the pressure different amounts in different people.

The only medicines that put the eye pressures up with open angle glaucoma are steroids (drugs or drops). These have many effects, and are usually only prescribed by doctors when they are reasonably essential. If your GP or rheumatologist prescribes these, expect your eye pressure to rise a little, and if your glaucoma is advanced let your ophthalmologist know before the next appointment. (Usually it is safe to let him know at the next appointment.)
Most other drugs do not affect the eye pressure, and few lower it a little.

Some drugs precipitate angle closure glaucoma in someone who already has narow angles. They will not increase eye pressure in someone who has the common type of chronic glaucoma.

Look after your general health, as this is often just as important as using the drops. Smoking damages the eye, and reduces the oxygen that reaches the optic nerve. Exercise lowers the eye pressure, and prevents other diseases (this includes walking or dancing, or in younger people rambling, swimming or cycling). A diet with lots of vegetables and fruit (5 x 100gm portions a day) will help indirectly, whereas a diet with lots of animal fat, dairy food, or salt, is not considered healthy. (Department of Health Guidelines). Remind your relations to be checked as glaucoma may run in families. Reading or using your eyes will not damage them.

Concerning the gap between drops..you need a 10 minute gap.
If you leave a 30 seconds gap, 50% is washed out by the next drop. (20%/2minutes, 4%/5 minutes).

Betablocker drops are well tolerated by the eye but have systemic side effects, and these are common in the elderly, and they generally must not be used in asthma patients. Because they are effective they are used a lot, and are very helpful if the glaucoma is not contolled with the prostaglandin inhibitors above.

Very effective at lowering the pressure. Maximum dose is 250mg qid (four times/day) or 250mg slow release bd (twice/day).
Side effects are proportional to patients weight, and increase with age.

Can be used in low dose eg 62.5mg tid, still with a significant effect.

Many, many side effects. Pins and needles. Patient can feel ill.
Effects vary highly from patient to patient, some tolerating tablets well.

1. xalatan or travavtan or lumigan at night is now generally first choice
   
   if that does not lower the pressure enough,
   
   
   
2. xalatan at night and add azopt 2-3 times a day (azopt can make the eyes sore and makes a few people a little ill)
   
   
3. or replace the xalatan with lumigan (lumigan can make the eyes red)...lumigan is sometimes more effective, occasionally a lot more effective.
   
   
4. Lumigan can be used with azopt.
   
   
5. travatan is equivalent to xalatan; If neither xalatan nor lumigan are effective, travatan is unlikely to be more effective.
   
   
6. Timolol once (LA) or twice a day helps often, and can be used in addition ot the others. Timolol in the very elderly (85y) is best used in its lower strength (0.25%). Aside from aggravating or causing asthma and other problems as above, it can be very helpful.
   One common regine is timolol LA in the morning, together with xalatan (or lumigan or travatan) in the evening.
   
   
7. So some patients, on one of the most effective regimes, will be using lumigan, azopt, and timolol.
   .......Timolol LA morning; azopt 2-3 x day; lumigan in the evening.
   
   
8. Alphagan causes problems in many patients, and is best avoided where possible.
   
   
9. Patients with very dry eyes...reduce the frequency of drops, and avoid azopt if possible; preservative free lubricants help. Consider preservative free drops such as timolol and pilocarpine.
   
10. reasons for poor compliance
    • cannot instill drops
    • make they eye sore
    • systemic side effects
    • not aware of the risk of glaucoma
    • forget to use them
      
11. Lumigan lowers the pressure 33%, timolol 26%.
    
    
12. Most drops have a 10% no response rate
    
    
13. Many drops contain Benzalkonium as a preservative. This may make they eyes red, especially if you have to use a lot of drops.
    If your eyes are red with the drops, discuss this with your doctor. Reducing the number of drops can be helpful. If you are definitely allergic to Benzalkonium you may need preservative free drops, but there is a limited choice.

Drops have not been tested in pregnancy

• the risky period concerning the foetus/baby is the first few weeks of conception, The last 2 trimesters are relatively safe.
• Pilocarpine is considered safe
• Betablockers are reasonably safe...perhaps consider a low dose such as nyogel (0.1% timolol)
• prostaglandins are not safe in the first trimester, but are probably safe breast feeding
• avoid a low blood pressure during delivery with advanced glaucoma