Tip: Beta Blockers are widely used and well-tolerated.

This group of compounds helps reduce intraocular pressure by decreasing the production of aqueous humor into the eye. These drugs are widely used and are generally well tolerated.

Beta-blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart’s response rate during exercise. Also, they can cause constriction of the bronchial airways and are contraindicated in patients with known obstructive airway disease.

If you have experienced dropping spells, syncopal attacks, episodes of a low heart rate or suffer from COPD, emphysema or asthma, please be sure to let your doctor know as he/she may avoid prescribing this group of drugs for you. Rarely your doctor may prescribe a selective beta-blocker which is better tolerated by patients with known lung problems.

Non-selective Beta Blockers Eye Drops:

Selective (Beta-2 selective) Eye Drops:

Drops with beta-blockers combined with another medication

Adverse Effects of Beta Blockers

Beta-blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders as discussed above. Side effects include low blood pressure, reduced pulse rate, fatigue and exercise induced shortness of breath. Rare side effects reported are reduced libido, depression and ocular allergies.

Tip: Carbonic Anhydrous Inhibitors are available as eye drops and pill form.

This group of compounds helps reduce intraocular pressure by decreasing the production of aqueous humor into the eye. They are related to the sulfa group of drugs. If you have experienced a serious allergic reaction to a sulfa compound, before please be sure to let your doctor know. Very often patients with a known sulfa drug allergy tolerate these glaucoma medications well.
Commercially these compounds are available both as eye drops and pills:

Eye Drops – Carbonic Anhydrous Inhibitors:

Drops with a carbonic anhydrase inhibitor combined with another medication

Pill – Carbonic Anhydrous Inhibitors:

Adverse Effects of Carbonic Anhydrous Inhibitors

Eye drops can cause stinging and burning upon instillation. The pill forms of these medications can cause a sensation of tingling and numbness in the fingers and toes, as well as around the mouth. Some patients may experience an upset stomach with a metallic taste in the mouth. Frequent urination, fatigue, mental fuzziness, memory problems, depression, and kidney stones have been reported with use of these drugs. Since these pills lead to a loss of potassium from the body fluids, some these side effects can be avoided by keeping hydrated and using natural sources of potassium along with these pills, such as eating a banana a day or drinking plenty of orange juice, Gatorade or other energy drinks that replenish body salts.

Tip: Alpha-Adrenergic Agonists reduce intraocular pressure.

This group of compounds helps reduce intraocular pressure by both decreasing the production of aqueous humor into the eye as well as improving the drainage of aqueous fluid through the uveoscleral pathway. Also brimonidine has been shown in experimental animal models of glaucoma to have a neuroprotective effect (preserve existing neural axons). This as yet has to be validated clinically.

Commercially these compounds are available as eye drops:

Your doctor may prescribe Alphagan (generic: brimonidine) or Combigan for the long-term treatment of glaucoma. Iopidine, however, is usually used in the clinic and is rarely prescribed as a take-home medication. It is used in the clinic to combat “pressure spikes” which are sharp increases in eye pressure that sometimes follow laser surgery. The eye technicians will instill this drop in your eye as they prepare your eye for laser surgery.

Adverse Effects Alpha-Adrenergic Agonists

Include burning or stinging upon instillation of the eye drop. Allergic reactions including redness of the eye and eyelids are common with the use of this group of drugs. Other side effects reported include fatigue, headache, dry mouth, and dry nose. It should be used with care in children as it can cause drowsiness and difficulty with breathing while asleep.

Miotics are parasympathomimetic agents.

These drugs work by constricting the pupil as well as other internal muscles of the eye; as a result, there is increased drainage of aqueous humor through the trabecular meshwork, reducing intraocular pressure. Constriction of the ciliary muscle pulls on scleral spur widening the pore size in the filter (trabecular meshwork) through which the eye fluid needs to pass for effective drainage.

Due to their side-effect profile, these drugs are nowadays rarely used in the routine treatment of glaucoma. However, in conditions such as narrow angle glaucoma and pigmentary glaucoma these drugs are sometimes preferred. In narrow angle glaucoma, constriction of the pupil with these drugs helps open the angle and improve drainage of intraocular fluid. Your doctor may choose to use these drugs prior to or in conjunction with a laser procedure. In pigment dispersion and pigmentary glaucoma, miotic drugs work by changing the configuration of the iris and reducing liberation of pigment.

Commercially these compounds are available as eye drops: