Glaucoma
Timolol
Brimonidine
Dorzolamide
Latanoprost
Question
Hi,
I am 70 and was detected with glaucoma when I was 57. By that time enough damage had happened. First I was on Timolol which brought down the IOP to 17 in each eye. The eye doctor introduced Latanoprost (0-0-1) when I was 60. When I was 62, during the times the IOP exceeded 20, I was added Dorzolamide (1-1-1) to bring down the IOP to less than 14 in each eye. Also other combinations Dorzolamide+Timolo1(1-0-1), Brimonidine+timolol)1-0-1) were tried.
Dorzolamide had too much of side effects causing burning sensation, dryness, discharge from the eye, hive-like swelling on the face, crust formation, blepheritis. But whenever the IOP would shoot up to 26, Dorzolamide was effective in bringing down to 14.
But I realized that even with Timolol (1-0-1) and Latanoprost (0-0-1) all these years the IOP has been below 20 with no changes in the fields, which remains almost the same as it was when I was 57. So the eye doctor was also OK with it. The cardiologist is OK with my ECG and does not feel adverse effect of Timolol.
However, because of the advancing age, my eye doctor now suggested trying other combinations and again prescribed Dorzolamide (1-1-1) which, even after using tear drops, I find it unbearable. Of course Latanoprost is regularly being used all these years.
As Dorzolamide is too troublesome, I want to know is it OK to try the following combinations provided the IOP remains around 14 in each eye with my following background? My pulse rate will be around 50-52 but BP will be normal with diastolic around 65-75 and diastolic around 105-120.
Whenever ECG is taken they mention as ?bradycardia?. When Timolol was first prescribed, the eye doctor had not checked my pulse rate nor my BP. So I am under the impression that my pulse rate has been below 60 all the time. But because of advancing age I want to avoid Timolol or use it to the minimum.
My diurnal study has indicated IOP tapering off towards evening. Hence can I try the following combination?
Brimonidine (1-1-1), Timolol (1-0-0),
Latanoprost or Travoprost (0-0-1)
Answer
Thanks for your Question
These three eye drops Brimonidine ,Timolol and latanoprost are powerful eye drops for glaucoma treatment and they are not from the same family or categories so there are no contraindications of using them in combination to lower your intraocular pressure.
In order to minimize the side effects of eye drops, we should decrease the systemic absorption of this medication and we can do so by pressing at the corner of the eye where the nasolacrimal duct is located, thus preventing the medication to reach the blood through nasolacrimal system. After applying the eye drops, press on this location for few minutes.
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