Medical Therapy of Glaucoma

The medical treatment of this disease is constantly changing. Most drugs are used as drops. Rarely are pills used. To aid in the identification of drops, bottle tops are usually color-coded.

There are several classes of medications which are presently used:

  1. Beta-Blockers
  2. Adrenergic Agonists
  3. Carbonic anhydrase inhibitors
  4. Prostaglandins
  5. Miotics
  6. Pills


1. The Beta-Blockers are the most commonly used drops. They have yellow tops. Commerical names include Timoptic, Betagan, Ocupress, Carteolol and Betimol. Generic medications are available. Patients with a history of asthma or heart disease must notify their doctors as these may cause significant side effects of lightheadedness and difficulty breathing. The drops are frequently used once or twice a day. Betoptic is a beta-blocker with a blue top. It has less breathing and cardiac side effects.

2. Adrenergic agonists have purple tops. The most commonly used one is Alphagan. It will not affect breathing. Older medications with purple tops include Epifrin and Propine. This are infrequently used due to ocular irritation and the availability of more effective agents.

3. Carbonic anhydrase inhibitor drops have orange tops. They include Trusopt and Azopt. They are used three times a day. They may cause a mild taste in the throat, but otherwise do not affect breathing or the pulse. A new drop is available which combines Timoptic and Trusopt in one bottle called Cosopt. It has a yellow top with an orange label.

4. Prostaglandin medications are the newest available treatment for glaucoma. The drop has a clear top. It is called Xalatan or latanoprost. The medication is taken once a day. The bottle cannot be left outside when the temperature is above 80 degrees and so refrigeration during the summer must be considered. Although it appears safe to be used with lung and heart disease, it has been change eye color in rare patients.

5. Miotic drops are the oldest treatment for glaucoma. They have green tops and include pilocarpine, carbachol, and phospholine iodide. They must be used three to four times a day. Side effects include blurred vision and headache. The pupil becomes very small following the use of these drops. Patients report dimness of vision which can improve with time.

6. Systemic pills for glaucoma include Diamox and Neptazane. These are carbonic anhydrase inhibitors. Although these pills are useful, they have greater side effects than the eye drops. Side affects include fatigue, disorientation, numbness in the extremities, an increased chance of kidney stones, and blood count changes. They are usually reserved for emergency treatment or postoperative care.