Summary

The mainstay of medical management for glaucoma comprises different varieties of topical drops. In this article we discuss the main drugs used and important side effects.

Prostaglandin Derivatives

MoA: Increasing uveoscleral aqueous outflow

Indication: Prostaglandin analogues have one of the best IOP-lowering effects, and are often preferred to beta-blockers as they have fewer side effects

Examples: Latanoprost, Travoprost, Bimatoprost, Tafluprost. All topical.

Ocular side effects:

• Conjunctival hyperaemia
• Eyelash thickening, lengthening and hyperpigmentation
• Iris hyperpigmentation
• Increased risk of cystoid macular oedema post cataract surgery

Systemic side effects:

• Mild - include headache, malaise, myalgia, skin rash

Latanoprost has the best side effect profile and is often the first line agent. The other, newer examples may have greater IOP-lowering effect, however.

<aside> 💡 Did you know: The iris hyperpigmentation which may occur as a side effect of prostaglandin analogue use is due to an increase in pigmented granules within the superficial stroma, and has nothing to do with melanocyte count?

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