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Medical Author:

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Hyperosmotics are sugar-based liquids meant to be taken by mouth. Hyperosmotics are used in the treatment of rapid-onset angle-closure glaucoma. The effects last only 6 to 8 hours, so they are not for long-term use. Hyperosmotics include mannitol (Osmitrol), glycerin (Osmoglyn), and isosorbide (Ismotic).

Who should not use these medications:

• Persons allergic to hyperosmotics
• Persons with severe renal disease
• Persons with severe dehydration
• Persons with pulmonary edema
• Persons with severe heart disease
• Persons with diabetes

Use: These drugs are given orally or by injection to rapidly correct high elevations of intraocular pressure.

Drug or food interactions: Hyperosmotics may decrease lithium levels.

Side effects: Hyperosmotics should be used with caution in people who have diseases worsened by salt retention.

Many patients with glaucoma require more than one type of medication for adequate control of their glaucoma. Combined medications can offer an alternative for patients who need more than one type of medication. In addition to the convenience of using one eye drop bottle instead of two, there may also be a financial advantage, depending on the insurance plan. Cosopt is a combination of a beta blocker (timolol) and a carbonic anhydrase inhibitor (Trusopt). Combigan combines an alpha agonist (brimonidine) with a beta blocker (timolol). Combinations of prostaglandin analogs and beta adrenergic blockers are available in Europe and are awaiting FDA approval in the United States.

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