Synopsis
Choose and administer topical pressure-lowering medicines safely, recognising class mechanisms, product-specific dosing, systemic contraindications and the place of combination treatment.
- Topical treatment lowers pressure by reducing aqueous production or improving outflow; the aim is to reduce future visual loss rather than restore damaged nerve tissue.
- A prostaglandin analogue is commonly selected when initial SLT is unsuitable, declined, awaited with interim treatment needed, or insufficient.
- Latanoprost 50 micrograms/mL is one drop per treated eye each evening; increasing the frequency can reduce its pressure-lowering effect.
Key red flags
New wheeze or collapse after starting a timolol-containing drop requires urgent medical assessment; check combination bottles because the beta-blocker may not be obvious from the brand name.
Investigation priorities
Identify duplicate ingredients, interacting medicines and unintended continued prescriptions.
Management branches
A glaucoma clinician selects topical therapy after considering diagnosis, laser suitability and visual risk.
- Confirm which eye needs treatment, the intended pressure goal and the medical or ocular factors that exclude particular classes.
- Choose an appropriate agent and formulation, state dose and timing clearly, and demonstrate bottle handling and measures that limit drainage into the nose.
Key medicines
Latanoprost 50 micrograms/mLApply one drop to the affected eye or eyes once each day, preferably in the evening, as continuing treatment until reviewed; if a dose is missed, resume the next scheduled dose.
Timoptol timolol standard aqueous dropsThe standard Timoptol product starts with one drop of 0.25% in the treated eye twice daily; if inadequate, 0.5% twice daily may be used. Review pressure at about four weeks and continue or reduce frequency only on instruction.