Miotics (Cholinergic Agents)

Common names include:

• Pilocarpine (Isopto Carpine, Pilocar, Pilagan, Ocusert, Pilopine)
• Carbachol / Carbamylcholine
• Echothiophate iodide (Phospholine Iodide)
• Physostigmine (Eserine ointment, Isopto Eserine)
• Demecarium bromide (Humorsol)
• Isoflurophate

Miotics increase fluid drainage out of the eye by helping to open the drainage network. Miotics also reduce the size of the pupil. Miotics may cause adverse drug interactions with certain anesthetic agents.

Possible side effects include, but are not limited to:

• Pain inside/around the eye or brow
• Blurred vision
• Headache
• Dim vision
• Retinal detachment
• Worsening myopia (nearsightedness)
• Cataract formation
• Increased tearing
• Gastrointestinal upset (abdominal cramps, nausea, diarrhea, etc.)
• Increased saliva production

Adrenergic Agents

• Epinephrine (Epifrin, Eppy/N, Glaucon, Epinal, Epitrate)
• Dipivefrin (Propine)
• Apraclonidine (Iopidine)
• Brimonidine (Alphagan)

Epinephrine constricts blood vessels in the eye and enlarges the pupil. It reduces the amount of fluid in the eye by reducing the production of fluid and increasing the amount of fluid drainage. Dipivefrin is transformed into epinephrine in the eye. Apraclonidine and brimonidine are known as alpha2-adrenergic agonists. They are thought to have less side effects. Adrenergic agents should be used with caution in patients with cardiovascular disease, as well as in patients taking certain antidepressant, heart, and blood pressure medications.

Possible side effects include, but are not limited to:

• Burning or stinging of the eye
• Red eyes (especially when medication is stopped)
• Allergic reaction
• Large pupils, causing increased sensitivity to light
• Colored deposits on the conjunctiva
• Elevated blood pressure and heart rate
• Abnormal heart rhythms
• Headache
• Anxiety

Apraclonidine is used to control eye pressure, especially after eye surgery.

Possible side effects include, but are not limited to:

• Dry mouth and nose
• Eye discomfort
• Allergic reaction
• Decreased blood pressure (potentially leading to fainting)
• Tiredness

Brimonidine is used to reduce pressure in the eye.

Possible side effects include, but are not limited to:

• Burning, stinging or tearing of the eye
• Blurred vision
• Allergic reaction
• Dry eye
• Drowsiness or fatigue
• Headache
• Decreased blood pressure
• Tiredness
• Depression
• Anxiety

Beta-Blockers

Common names include:

• Timolol maleate (Timoptic XE, Timoptic, Ocudose, Timolol Gel)
• Timolol hemihydrate (Betimol)
• Levobunolol (Betagan)
• Metipranolol (OptiPranolol)
• Carteolol (Ocupress)
• Betaxolol (Betoptic)

Beta-blockers work to lower the intraocular pressure by decreasing the rate at which fluid flows into the eye. Beta-blockers are usually contraindicated in patients with such medical conditions as asthma, chronic obstructive pulmonary disease, slow heart beat, heart block, heart failure, or other heart or lung problems.

Possible side effects include, but are not limited to:

• Blurred vision
• Eye irritation
• Allergic reaction
• Breathing difficulty
• Slowing pulse rate
• Hair loss
• Decreased blood pressure
• Impotence
• Dizziness or fainting
• Fatigue and weakness
• Hallucinations
• Insomnia
• Depression
• Memory loss

Prostaglandin Analogs

• Bimatoprost (Lumigan)
• Latanaprost (Xalatan)
• Travoprost (Travatan)
• Unoprostone (Rescula)

Prostaglandin analogs reduce pressure in the eye by increasing the outward flow of fluid from the eye.

Possible side effects include, but are not limited to:

• Darkening of the iris (colored part of the eye)
• Darkening and increased growth of eye lashes)
• Conjunctival hyperemia (red eyes)
• Eye irritation
• Flu-like symptoms
• Body aches and pains

Carbonic Anhydrase Inhibitors

Common names include:

• Dorzolamide (Trusopt)
• Dichlorphenamide (Azopt)
• Acetazolamide (Diamox)
• Dichlorphenamide (Daranide)
• Methazolamide (Neptazane)

Carbonic anhydrase inhibitors inhibit the enzyme carbonic anhydrase, which results in a reduction of the production of fluid in the eye. Oral forms are usually only used in emergent situations, such as in an angle-closure attack. They are contraindicated with history of sulfa allergy and should be used with caution in patients with certain medical problems such as blood disorders or liver disease. Blood cell counts are often monitored regularly while taking these drugs.

Possible side effects include, but are not limited to:

• Frequent urination
• Tingling or numbness sensation in the fingers or toes
• Kidney stones
• Rashes
• Depression, fatigue, and lethargy
• Weight loss
• Gastrointestinal upset
• Diarrhea
• Impotence
• Unpleasant taste in mouth
• Abnormal lab tests:
  • Abnormal blood electrolytes (especially potassium)
  • Abnormal blood cell count (red or white blood cells or platelets)