About Common Glaucoma Medications

Important reminders

A brief description of the most commonly used eye drops is provided below. Possible side effects of each of these drugs are also listed. This is not meant to be an exhaustive list of side effects. For more information, we recommend that you consult your pharmacist.

Preventing Side Effects

You can prevent most bodily side effects by pressing in the corner of your eye next to your nose for about 30 seconds, after applying the eye drops. This is called punctal occlusion and prevents the drops from draining through your tear ducts, into your nose, mouth and throat and affecting your body.

Generic drugs

Side effects mentioned for brand name drugs are the similar for generic versions of these drugs.

What should I do if I am experiencing medication side effects or a possible allergic reaction?

If you think you are experiencing any undesirable side effects or an allergic reaction (redness, swelling of lids, itching) from any of these drugs, you can stop the medication, and call the office for a follow-up appointment to ensure that other treatment options are considered and that you are being monitored. If you are experiencing any severe symptoms like shortness of breath, wheezing, extreme fatigue or extreme facial swelling, you should STOP the medication and call 911, or go to your local emergency department immediately.

Are these medications safe for pregnancy or nursing?

IF YOU ARE PREGNANT OR PLANNING TO BECOME PREGNANT OR NURSING, SOME OF THESE MEDICATIONS MAY NOT BE SUITABLE FOR YOU: PLEASE NOTIFY YOUR DOCTOR. MAKE SURE YOU UPDATE YOUR DOCTOR WITH YOUR CURRENT MEDICATION LIST TO AVOID DRUG INTERACTIONS.

Is sharing eye drops okay?

DO NOT SHARE your eye drops with other people for what you think may be related problems. Shared use of medications can cause damage to the eyes. For example, if someone is unknowingly using a steroid eye drop for weeks to months, (s)he may develop high eye pressures that lead to vision loss. High eye pressure that comes on slowly does not usually cause pain, therefore this person maybe losing vision slowly without having warning signs.

How do I dispose of eye medications?

Dispose of your eye medications: by returning them to the pharmacist or your eye doctor for safe disposal.

How do I apply eye drops or eye ointment?

For information on proper application of eye drops or ointment, please see the relevant sections.

XALATAN ® (latanoprost 0.005%), LUMIGAN RC ® (bimatoprost 0.01%) and TRAVATAN Z ® (travoprost 0.004%):

These medications are in the same class of drugs called the "hypotensive lipids" or "prostaglandin analogues". These are eye drops that are used by dropping one drop into the affected eye(s) at bedtime on an ongoing basis to decrease eye pressure. You may be prescribed any one of these drugs to begin glaucoma treatment, and possibly switched to a different drop if the first one that is tried is not getting your pressure low enough. These medications work by increasing the drainage of fluid from your eyes through an alternate drainage pathway. Common side effects of this group of medications are: REDNESS, DARKENING AROUND THE EYES, LENGTHENING OF EYELASHES, DARKENING OF EYE COLOUR, CHANGES TO THE EYELIDS AND DEEPENING OF THE EYE SOCKET (PROSTAGLANDIN ASSOCIATED PERIORBITOPATHY or PAP).

Eye redness improves as your eyes get used to the drug over a few weeks. You can reduce the darkening around the eyes by wiping the drop residue with a wet tissue (instead of a dry one). This darkening is a reversible effect of the drug and will disappear if the drug is stopped. Changes to the eyelids and deepening of the eye sockets are also reversible once this type of eye drop is stopped (or there is a change from bimatoprost to latanoprost). Eye colour sometimes may become darker over time with use of these types of medications and does not usually change after they are stopped.

These medications can also cause your eyelashes to grow longer and fuller while you are on them. Interestingly, a cosmetic product called LATISSE ® has been developed for increasing eyelash growth and is derived from bimatoprost. These medications are not recommended for women who are pregnant or planning to become pregnant (barring exceptional circumstances). Generally speaking, this class of drug is very well tolerated. However, if you are finding that they are too irritating to your eyes, you can stop using the drug, and call your Optometrist or Ophthalmologist to arrange a prompt follow-up to consider treatment options. We recommend that you do not stop them just because of redness if this is the only issue. Redness of the eyes will improve with time as your eyes get used to the drug.

MONOPROST® (latanoprost ophthalmic solution), 50 µg/mL [preservative-free];

ZIMED® PF (bimatoprost 0.03%) [preservative-free]

These are preservative-free preparations of some prostagladin analogues. They come in single dose plastic vials that are used daily usually at night. These are helpful for patients who are allergic to preservatives or are experiencing extreme dry eye. They tend to be more expensive than their non-preserved counterparts.

VYZULTA™ (latanoprostene bunod ophthalmic solution, 0.024%)

Vyzulta™ is made up of latanoprost and a nitric oxide moiety, both of which lower the eye pressure by increasing drainage from the eye by different pathways. It is dosed every 24 hours, usually at night, and has similar side effects to latanoprost. It can cause more irritation and redness than the prostaglandin analogues, therefore if you are not tolerating it, it is best to discontinue the medication and call your Optometrist or Ophthalmologist for a follow-up appointment.

TIMOLOL 0.5%®, TIMOPTIC XE® (timolol maleate gel 0.25%, 0.5%), BETAGAN® (levobunolol 0.5%), BETOPTIC S 0.25%®:

These are all BETA-BLOCKER type eye drops that work to lower your eye pressure by decreasing the production of fluid inside your eyes. It is like turning the taps down when a sink is blocked to decrease the build-up of water in the sink. In a sink, the water overflows over the edges, whereas in the eye, the fluid build-up causes the eye pressure to increase because the drainage channels cannot keep up with the increased amount of fluid to drain. The pressure builds up inside this "closed" system. The gel form is used once a day in the morning and can cause temporary blurry vision (10-15 minutes), and the drop forms (all the rest) are used every 12 hours in the affected eye(s).

Possible side effects of these medications can include tiredness, fatigue, shortness of breath and increase in wheezing in patients with asthma or COPD (being treated with inhalers), temporary impotence in men (only while on the drug) and depression. Certainly, if you have a history of asthma, COPD or depression, you will likely not be offered these drugs or any of the combination drugs that include beta-blockers in them (although Betoptic® may be considered for use since it usually has less of a respiratory side effect). These medications are not recommended for women who are pregnant or planning to become pregnant (barring exceptional circumstances). If you develop any of the above side effects, please stop the drug and call your Optometrist or Ophthalmologist for a prompt follow-up appointment to consider alternate treatment options.

ALPHAGAN P 0.15%® (brimonidine 0.2%):

This is an alpha-adrenergic agonist type of drug. They work like beta-blockers in that they lower your eye pressure by decreasing the production of fluid in the eye, thereby decreasing the build-up of fluid and the increase in eye pressure that goes along with fluid build-up. This drug is used 2-3 times per day in the affected eye(s). Possible side effects include tiredness and fatigue. Since these drugs can have more severe effects in small children and petite, elderly persons, they are usually not used in these cases (although they may be tried barring other better options for treatment especially in the case of advanced glaucoma). These medications are not recommended for women who are pregnant or planning to become pregnant (barring exceptional circumstances). There is an increased likelihood of developing a drug allergy to brimonidine. Allergic symptoms can develop at any time, even years after using this drug without problems. They usually involve profound redness, itchiness of the eyes, and sometimes puffiness of the lids. If you experience allergic symptoms or fatigue while on this medication, stop it and call your Optometrist or Ophthalmologist for a prompt follow-up appointment to consider treatment options.

AZOPT® (brinzolamide 1%), TRUSOPT® (dorzolamide 2%):

These are sulpha-based eye drops that are applied to the affected eyes 2-3 times per day. They are in the class of drug called carbonic anhydrase inhibitors. These medications work to lower eye pressure by decreasing fluid production in the eyes (similar to beta-blockers and brimonidine). Both tend to sting the eyes when applied (Azopt® is a little less stingy). Azopt® is a suspension, therefore, it needs to be shaken thoroughly before being applied. Side effects include stinging and a bad taste in the mouth, however they are generally well tolerated. Carbonated drinks may have a metallic taste while using these drugs. Applying pressure to the corner of the eye close to the nose will prevent the eyes drops from going down your tear duct into your nose and stinging your throat. These medications are not recommended for women who are pregnant or planning to become pregnant (barring exceptional circumstances). These drops are not suitable for patients who are allergic to sulpha-based medications. If you develop an allergic reaction to this drug (redness, itching, puffiness around the eyes) or are unable to tolerate them, you can stop them and call your Optometrist or Ophthalmologist to arrange a prompt follow-up appointment.

ISOPTO CARPINE ®, PILOPINE ® gel (pilocarpine 1%, 2% or 4%):

This is a parasympathomimetic drug that makes your pupil very small (miotic). It is an older drug but lowers eye pressure by essentially stretching open the drainage system. These drops are used 4 times per day (unless otherwise instructed) in the affected eye(s) or the gel is used at night in the affected eye(s). Possible side effects are blurred vision and dimming of lights, headache and allergic symptoms such as redness and itching. More severe possible side effects include retinal detachment and loss of vision (especially in very near-sighted people), precipitation of an angle closure glaucoma attack (rarely), shortness of breath, muscle tremors, severe sweating, excessive salivation, stomach pain, vomiting and diarrhea. These are rare side effects, especially with topical drop use. These medications are not recommended for women who are pregnant or planning to become pregnant (barring exceptional circumstances). If you experience any of these side effects, stop the medication and call your Optometrist or Ophthalmologist for a prompt follow-up appointment. If you experience severe side effects, call 911 or go to your local emergency department.

COMBINATION DROPS FOR TREATMENT OF GLAUCOMA: COMBIGAN®, COSOPT®, AZARGA®, DUOTRAV®, XALACOM®

• Combigan® - combination of timolol 0.5% and brimonidine 0.2%
• Cosopt® - combination of timolol 0.5% and Trusopt® (dorzolamide 2%); also available [preservative-free]
• Azarga® - combination of timolol 0.5% and Azopt® (brinzolamide 1%)
• Duotrav® - combination of timolol 0.5% and Travatan® (travaprost 0.004%)
• Xalacom® - combination of timolol 0.5% and Xalatan® (latanoprost 0.005%).

Some of these drugs have different names in other countries. The application of Combigan®, Cosopt® and Azarga® is every 12 hours to the affected eye(s). Azarga® needs to be shaken before use (since it is in a suspension). Duotrav® and Xalacom® are applied once daily to the affected eye(s) usually in the morning. Possible side effects of these combination medications are the same as for the individual medications (see above). These medications are not recommended for women who are pregnant or planning to become pregnant (barring exceptional circumstances). If you experience an allergic reaction (itching, redness, swelling of lids) or any intolerable or severe side effects, you can stop the medication and call your Optometrist of Ophthalmologist for a prompt follow-up appointment. If you experience severe side effects like shortness of breath or facial swelling, you should go to your local emergency department immediately.