11.6 Treatment of glaucoma

General Guidance

• The rise in intraocular pressure almost always due to reduction in outflow of aqueous humour, the inflow remaining constant.
• The most common form of glaucoma is primary open angle glaucoma, where a topical beta-blocker is considered the first line therapy. Other drugs such as dorzolamide, pilocarpine or brimonidine may be added if the glaucoma is not well enough controlled.
• Latanoprost is indicated for open angle glaucoma and ocular hypertension in patients unresponsive to other therapy, or when they are contra-indicated.
• Miotics such as pilocarpine are used in the management of closed angle glaucoma.
• A combination of products such as Cosopt may be used for patient’s convenience if both drugs are required.

​Beta blocker

Timolol topical

 

Prostaglandin

Latanoprost topical

Bimatoprost topical 100micrograms/ml multidose eye drops (300micrograms/ml multidose eye drops being discontinued June 2015)

Bimatoprost topical 300micrograms/ml single-dose eye drops for patients requiring preservative free drops’

Travoprost topical

Tafluprost topical

Latanoprost with timolol topical

Bimatoprost with timolol topical

Travoprost with timolol topical

 

Sympathomimetics

Brimonidine topical

 

Carbonic anhydrase inhibitors and systemic drugs

Acetazolamide oral

Brinzolamide topical

Brinzolamide and brimonidine eye drops (Simbrinza)

Brinzolamide with timolol (Azarga) topical

Dorzolamide topical

 

Miotics

Pilocarpine topical

 

Combination products

Xalacom (Latanoprost With timolol)

Combigan (Brimonidine + timolol)

Fixapost (Latanoprost + Timolol) PF single dose units - Ophthalmology recommendation or initiation only if intolerance to preserved version

 

ACE non-approved drugs

Bimatoprost 0.01% (Lumigan)

 

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

 

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low