These are your first line of defence against an eye condition.

You may experience conflicting emotions after a glaucoma assessment. It can be quite lengthy and can lead to several different feelings.

According to Christopher Starr, MD, an ophthalmologist at Weill Cornell Medicine and New York-Presbyterian, most patients have a pretty standard first option for treatment: prescription Eye Drops. What’s the reason? How can you treat glaucoma? Eye drops are a good option.

Dr Starr states that Eye Pressure is the main modifiable risk factor in glaucoma. So we treat the pressure. Dr Starr explains that many types and classes of eye drops can reduce eye pressure in various ways. He said that certain reductions could reduce water production and others increase the fluid flow to the eye. To combat eye pressure from different angles, people with advanced glaucoma might need to use several kinds of eye drops.

Courtney Ondeck MD is an ophthalmologist with the Glaucoma Service at Mass Eye & Ear. Not everyone responds well to each type of eye drop. Your doctor will likely recommend a kind of eye drop, usually a prostaglandin analogue. They only need to be used for a single day, and then you’ll wait to see if your eyes pressure drops. If the fall doesn’t work, the doctor will recommend another eye drop from that class, another category, or a mixture of two different depths. If the eye drops do not reduce your eye pressure, your doctor may recommend other invasive treatments such as surgery and lasers.

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There are seven types overall of eye drops to treat glaucoma. Here is what you need to know.

Prostaglandin analogues

These drops increase the fluid flow to the eyes. Dr Ondeck informs that most patients tolerate the drops well, and there are very few side effects. According to the Glaucoma Research Foundation, side effects can include eye colour change, darkening eyelid skin, eyelash growth, droopy eyelids, sunken eyes, stinging, eye redness, and itching. Dr Ondeck says that prostaglandins and all other eye drops may cause some dryness.

These eye drops can only be used once daily, so doctors prefer to give them a try first. There’s a greater chance that patients will use the prescribed dosage, increasing their effectiveness. Dr Ondeck states that compliance is a serious problem. “It is easier to remember to take my medication once a week than three times a day.”

Here are some examples of prostaglandin analogues Tafluprost ophthalmic solution (Zioptan), Bimatoprost (Lumigan), Latanoprostene bunod (Vyzulta), Travoprost (Travatan), Latanoprost (Xalatan), Latanoprost ophthalmic emulsion (Xelpros)

Beta-blockers

Beta-blockers are used to reduce eye pressure by decreasing fluid production. Side effects of drops in this class can be systemic. This means they may have effects that go beyond the eyes. These side effects are similar to how other beta-blockers (usually given to people with high blood pressure) work and can include low blood pressure, fatigue, and reduced pulse rate. Beta-blocker eye drops can also cause shortness of breath in people with asthma or respiratory conditions like COPD, which is why Dr Ondock says she doesn’t prescribe them to people with these health conditions. Beta-blockers can occasionally cause depression or reduced libido.

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This class of medications only needs to be taken one time per day. They can be an option for people with no pre-existing medical conditions.

Some examples of beta-blockers Timolol hemihydrate (Betimol), Timolol Maleate, Levobunolol HCI ophthalmic solution (Betagan), Metipranolol (OptiPranolol), Timolol Maleate Ophthalmic Solution (Install), Betaxolol HCI (Betoptic)

Carbonic anhydrase inhibitors (CAIs).

This class of medications works by decreasing the aqueous production in your eye. You can also buy them in pill or eye drop form. Dr Ondeck states that the drops may cause burning or sting in the eyes. Glaucoma Research Foundation says that side effects can include tingling or weakness in the hands and feet and nausea, memory problems and depression, frequent urination and kidney stones. Dr Ondeck warns that kidney-related issues should not be ignored.

Dr Ondeck mentions that CAIs should be taken three times daily to lower eye pressure. For some, compliance may be a problem.

Examples of CAIs Methazolamide (Neptazane), Dorzolamide HCI (Trusopt), Brinzolamide ophthalmic suspension (Azopt), Acetazolamide (Diamox Sequels)

Alpha agonists

Alpha agonists reduce fluid production in the eyes and increase drainage. Only two types of drops are included in this class: Brimonidine and Apraclonidine. Dr Ondeck says these drops can cause pretty bad conjunctivitis (pink eye) and significant fatigue in older patients. According to the Glaucoma Research Foundation, other potential side effects include burning or stinging in the eye, headache, drowsiness, dry mouth, and dry nose. Brimonidine, in particular, is contraindicated for children and infants because it passes through the blood-brain barrier and has been shown to cause central nervous system (CNS) depression and toxicity, resulting in conditions like low blood pressure, slow heart rate, and hypothermia.

To maximize effectiveness, you should take these drugs three times daily.

Examples of alpha agonists Brimonidine tartrate (Alphagan), Apraclonidine HCI (Iopidine)

Cholinergics (miotic)

These drops make the pupil smaller, which allows for more fluid to drain from the eyes. A most common side effect is blurred vision, particularly at night and in darkened areas. However, they can cause systemic side effects like increased sweating or loss of bladder control. They can also cause muscle weakness, decreased blood flow, fatigue, nausea, vomiting, shortness and breathing problems, and slow heartbeat. According to the Glaucoma Research Foundation, cholinergic eye drops are not commonly prescribed anymore because of their potential side effects and the fact that there are many other options.

Examples of cholinergic Pilocarpine HCl (Isopto Carpine, Pilopine HS Gel), Carbachol (Isopto Carbachol)

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Rho-kinase inhibitors

Dr Ondeck says this is the most recent class of glaucoma-related eye drops. She also states that glaucoma specialists are excited about the potential to treat high pressure. “So far, it has worked well and has reduced the number of surgeries that we have done,” she said. They work by improving the outflow of the trabecular meshwork, according to the Glaucoma Research Foundation. These drops have no known side effects. However, some can cause redness, stinging and corneal deposits. Dr Ondeck adds that corneal bleeding and corneal deposits do not appear to affect vision.

Netarsudil, a rho kinase-inhibiting eye drop, is currently available on the marketplace. It can be used at night only once daily.

Combination treatments

Combination medication is simply two types of eye drop combined into one drug. Dr Ondeck states that people may need to use two eye drops to manage their eye pressure. A combination drop can help make this easier and improve compliance. “Sometimes they are only brand-name drops so that it can be a problem with insurance approval,” she says. (Depending on which insurance plan you have, it may be more beneficial to only have one medication.

Here are some examples of eye drops that can be used in combination with each other: Rocklatan is a prostaglandin analogue, and Rho kinase inhibition; Combigan (beta-blocker and alpha antagonist); Cosopt (beta-blocker and carbonic anhydrase inhibitor, also generically available and without preservatives); Simbrinza is a carbonic anhydrase blocker and an alpha agonist).