Understanding Glaucoma Medications (cont.)
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Carbonic Anhydrase Inhibitors
Carbonic anhydrase inhibitors were initially developed as agents to treat high blood pressure (hypertension) but then were found to also decrease intraocular pressure. They reduce the action of an enzyme called carbonic anhydrase, which is necessary for the production of aqueous fluid. The carbonic anhydrase inhibitors include oral agents acetazolamide (Diamox) and methazolamide (Neptazane, GlaucTabs) and eye drops brinzolamide (Azopt) and dorzolamide (Trusopt). The pills are rarely used today for the treatment of either glaucoma or hypertension but are effective in the treatment of altitude sickness. The drops are currently used as fourth-line therapy in glaucoma and are often used in combination with other glaucoma drops.
Who should not use these medications:
Use: These drugs are given as eye drops, pills, and for glaucoma emergencies, injections.
Drug or food interactions: When administered systemically, such as with pills or injections, carbonic anhydrase inhibitors may decrease therapeutic levels of lithium and alter the body's elimination of amphetamines, quinidine, phenobarbital, or aspirin.
Side effects: Individuals with liver disease may become comatose with oral administration. Eye drops may cause irritation of the eyelids.
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While any type of glaucoma can be unilateral, primary open-angle glaucoma, primary angle-closure glaucoma, primary infantile glaucoma, juvenile-onset glaucoma, and pigmentary glaucoma are generally bilateral diseases, the severity of which may be asymmetric in the two eyes.