Glaucoma / ocular hypertension
- Lower intraocular pressure to prevent optic-nerve damage
- Prostaglandin analog is common first-line drop
- Add beta blocker, alpha-2 agonist or CAI as needed
- Laser trabeculoplasty can be first-line
- Surgery for progressive/refractory disease
- Adherence + correct drop technique are essential
Use at a glance
- Lower intraocular pressure to prevent optic-nerve damage
Treatment options
- Prostaglandin analog is common first-line drop
Escalation / refractory disease
- Laser trabeculoplasty can be first-line
- Surgery for progressive/refractory disease
Practical pearls
- Add beta blocker, alpha-2 agonist or CAI as needed
- Adherence + correct drop technique are essential
Key points
- 1st-line: topical IOP-lowering drugs; start with PGA monotherapy
- IOP above target on PGA → add/substitute topical β-blocker, CAI, selective α2-agonist, or netarsudil
- Laser trabeculoplasty or surgery: alternatives to drops
Nonpharmacologic therapies
- Nasolacrimal duct occlusion
- Selective laser trabeculoplasty
- Argon laser trabeculoplasty
- Trabeculectomy
- Minimally invasive glaucoma surgery
- Intracameral drug implants
Pearls
- Press nasolacrimal duct one minute to cut systemic absorption
- PGAs can permanently darken mixed-color irides; lengthen lashes
- Topical β-blockers act systemically; betaxolol gentler but weaker
- Topical CAIs usually tolerated despite sulfonamide allergy
- Selective laser trabeculoplasty can be repeated as effect wanes
Self-check
- Can laser trabeculoplasty be first-line?
Yes. - What treats progressive/refractory glaucoma?
Surgery.
Drugs used for this (14)
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