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Eye drops for glaucoma

Key points about eye drops for glaucoma

Although glaucoma cannot be cured, it can usually be stopped from getting worse.
Common treatments include medicated eye drops which reduce the pressure in your eye, either by helping the fluid drain from the eye, or by reducing the amount of fluid produced.
Find out about how to use eye drops for glaucoma and possible side effects.

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Glaucoma specialist – Dr Sonya Bennett provides an understanding of how lowering the pressure works, talks broadly about eye drops in a simplified way and discusses the challenges with eye drop treatment for both the patient and the eye specialist.

(Glaucoma, NZ, 2019)

There are many different types of eye drops used to treat glaucoma.

Some drops work better in some people than in others. The possible side effects vary between the different types of drops. So, if the first does not work so well, or does not suit, another may work better. For some people, multiple combination of eye drops may be needed to reduce the eye pressure.

Types of eye drops	Description
Prostaglandin analogues	These are the most commonly used eye drops for glaucoma and help increase drainage of fluid out of your eye. Examples include: bimatoprost (Lumigan®, Multichem®) latanoprost (Hysite®) travoprost (Travatan®, Travopt®). Possible side effects include: changes in eye colour increased growth and thickness of eyelashes sunken appearance to eyes red eyes and irritation.
Beta-blockers	These eye drops reduce the production of fluid in the eye. Examples include: betaxolol (Betoptic ®, Betoptic S®) levobunolol (Betagan®) timolol (Arrow-Timolol®, Timoptol-XE®) dorzolamide + timolol (Arrow-Dortim®) These eye drops are not suitable if you have breathing problems such as asthma or COPD. Possible side effects include: shortness of breath, reduced exercise tolerance vivid dreams impotence irritated eyes.
Other eye drops	Examples of other eye drops include: brimonidine (Alphagan P®, Arrow- Brimonidine®) brinzolamide (Azopt®) dorzolamide (Trusopt®) : being discontinued in Aotearoa New Zealand in 2023. pilocarpine (Pilopt®, Isopto Carpine®) Possible side effects include: dry mouth and dry eyes red eye stinging sensation to the eye metallic taste headache.

To reduce the effects of glaucoma, it’s important to use your eye drops every day, in the way your doctor has told you to. The effect of the medication wears off so if you do not use your eye drops on time, your eye pressure will rise even though you cannot feel it. If you miss using your drops, apply them as soon as you remember, but if it is closer to your next scheduled dose then just apply your dose as usual.

Speak to your doctor if you develop any of these side effects. They will be able to change your medications, or suggest alternative therapy such as laser or surgery. Do not stop your medication without checking with your doctor.
Note: sometimes people react to preservatives present in the eye drops. Currently there is no funded preservative free eye drops available in NZ.

How to use eye drops

When using eye drops, press the inside corner of your eyelids immediately after putting in the drop, blot off any excess with a tissue and keep your eye closed for 2–3 minutes. This helps to stop the drops from going down the tear duct and being absorbed into the body. Read more about how to use eye drops.

If you are having trouble getting the drop into your eye, lie down flat, face up, with your eye closed. Place the drop outside of the lid in the corner of your eye near your nose. As you open your eye, the drop will roll in.
If you are not sure if the drop actually got into your eye, put in another. The eyelid can hold only about one drop, so any excess will run out of the eye.
If you are having trouble holding onto the bottle, try wrapping a paper towel around the bottle to make it wider or alternatively use an eye drop dispenser. This is a plastic device in which you place the eye drop bottle. It makes holding the eye drop bottle easier and helps you to guide the eye drop into your eye. Ask you pharmacist about an eye drop dispenser.
If you can’t put the drops in yourself, ask a family member or friend to help you. Let your doctor know if it is too difficult.

Using more than 2 types of eye drops

If using 2 or more types of drops at the same time, wait 5 minutes before putting the next drop in your eye to prevent dilution of the first medication.

If you are using contact lenses, remove them before using the eye drops and do not replace them until 15 minutes after using the drops.

(Moorfields Eye Hospital NHS Foundation Trust, 2014)

Eye drops are absorbed by the surface of your eye as well as going into your bloodstream. This means they can cause side effects in other parts of your body. Usually, side effects lessen after a few weeks. However, you should ask your doctor about any physical or emotional changes that occur when taking glaucoma medications. If the side effects are troublesome or last a while, your doctor can prescribe another medication.

Make sure that you tell all of your doctors, including your GP about any glaucoma medications you are taking and any side effects you are experiencing.

Glaucoma and eye drops – Dr Sonya Bennett(external link) Glaucoma NZ
Bimatoprost 0.03% eye drops - Lumigan brand change(external link) Pharmac, NZ