The main goal of glaucoma treatment is to reduce intraocular pressure to prevent damage and preserve the functions of the optic nerve. As a rule, glaucoma treatment begins with the appointment of drops that reduce intraocular pressure. These drops need to drip constantly, strictly according to the instructions of the doctor.
The regularity of their instillation is, to a certain extent, a guarantee of success of the treatment. With the ineffectiveness of some drops in maintaining normal intraocular pressure, the doctor can you strengthen mode by assigning further drops other chemical groups, moreover, that some droplets may potentiate other.
All eye drops are absorbed through the superficial vessels into the eye bloodstream and, albeit in small quantities, but still enter the systemic bloodstream. The active chemicals of some drops from glaucoma have adverse side effects on the cardiovascular and respiratory systems of the body, so it is very important for an ophthalmologist to know your common chronic diseases.
If the patient, due to his general condition or for some other reasons, is not able to regularly instil drops from glaucoma, then it is better for him to suggest other methods of treatment.
Types of drops to reduce intraocular pressure
To date, there are many different drugs for the treatment of glaucoma in the form of eye drops, which are classified:
- by active chemical: prostaglandins, beta-blockers,cholinomimetics, etc.,
- on the mechanism of reducing intraocular pressure: reducing the production of intraocular fluid, improving the outflow of intraocular fluid and preparations of the combined mechanism of action.
Prostaglandins are highly effective and safe drugs for glaucoma. Intraocular pressure decreases after 2 hours after instillation, the maximum effect is achieved after 12 hours.
These drugs: Travatan (Alcon), Xalatan (Pfizer), Tafluprostum, etc., have appeared relatively recently. However, due to their high effectiveness and duration of action (they need to be instilled only 1 time per day), they have proven to be the drug of choice in the treatment of glaucoma.
The mechanism of their action is based on the improvement of the outflow of intraocular fluid through an additional outflow path.
But drugs of the prostaglandin group have a number of side effects: transient reddening of the eyes (due to dilated superficial vessels), discoloration of the iris (it becomes darker) and increased eyelash growth (they become thicker, longer and darker).
The last side effect of prostaglandins, which pleases some patients, has also been used by cosmetic companies.
This group of drugs reduces the production of intraocular fluid. They begin to act 30 minutes after application with the maximum effect after 2 hours, so the frequency of their instillation is usually 2 times a day. They are often prescribed in combination with prostaglandins to enhance the effect.
Timololum , Arutimol is an incomplete list of existing beta-blockers used in the treatment of glaucoma. As a rule, they have one active chemical substance, so they are interchangeable.
But these drugs have a number of side effects: a decrease in heart rate, bronchospasm, etc. Therefore, these drugs are contraindicated for people with certain heart diseases, bronchial asthma, pulmonary emphysema.
There are highly selective beta blockers Betoptic and Betoptic C (Alcon), their side effects on the cardiovascular and respiratory systems are less pronounced than in other drugs in this group.
Carbonic anhydrase inhibitors
Carboanhydrase inhibitors: Azopt (Alcon), Trusopt, – reduce the production of intraocular fluid. These are highly effective and safe drugs that have no side effects on the cardiovascular and respiratory systems, but should be used with caution in people with certain kidney diseases.
Carboanhydrase inhibitors are usually administered 2 times a day and, if necessary, can be administered in combination with other drops, for example, beta-blockers or prostaglandins.
Tableted drug Diacarb has the same active ingredient as Azopt, and can also be used in the treatment of glaucoma, especially in acute and subacute attacks of glaucoma.
These drugs (Pilocarpinum, Carbocholinum) improve the outflow of intraocular fluid by constricting the pupil and reducing certain groups of intraocular mice, which makes it easier for intraocular fluid to pass through the anterior chamber angle.
Pilocarpine, as the main representative of this group, is most often prescribed for narrow-angle or angle-closure glaucoma in order to lift the drainage network from the iris root. Appointed on average 1-2 times a day. If necessary, pilocarpine is prescribed in combination with other drugs, for example, beta-blockers, carbonic anhydrase inhibitors, prostaglandin analogues.
Side effects of pilocarpine are caused by a narrow pupil, which can limit the field of view and cause unpleasant pain in the forehead, eyebrows, temple.
Developed drops containing several active chemicals in one bottle. With the appointment of several drugs at the same time, and this happens quite often, the use of combined drops reduces the number of bubbles and sometimes reduces the rate of instillation.
Neuroprotectors in the treatment of glaucoma
Neuroprotective treatment, i.e. treatment aimed at improving nutrition, blood supply to the optic nerve, plays an important role in the prognosis and course of glaucoma. Studies examining changes in the optic nerve in glaucoma prove the feasibility and necessity of neuroprotective treatment in any form of glaucoma, especially in advanced and advanced stages.
It is important to note that there are studies proving some neuroprotective action of antiglaucoma drops: prostaglandin analogues , beta- blockers, etc. But, as a rule, this is not enough.
To date, there are many drugs of different origin and chemical composition, which have certain neuroprotective properties. The main groups of neuroprotectors :
- Blood circulationenhancers: Ginkgo biloba, trental, dicinone and others
- Means that improve the regeneration of nervous tissue: Picamelone, cinnarizine, nootropil, fezam, etc.
- Means that activate the nutrition of the nervous tissue: Retinalamin, Cortexin, Semax, Cerebrolysin, and others.
- Antioxidants and Vitamins: Emoxipine, Mexidol, Ascorbic Acid, Vitamin E, Vitamins B, Riboxin, Lutein Complex, and others.