Editing Glaucoma (section)

===Medication===
{{Main|Glaucoma medication}}
There are several pressure-lowering medication groups that could be used in lowering the IOP, usually eyedrops. The choice of medication usually depends on the dose, duration and the side effects of each medication. However, in general, [[prostaglandin analogue]]s are the first-line treatment for glaucoma.<ref name=":4">{{Cite journal |last1=Weinreb |first1=Robert N. |last2=Aung |first2=Tin |last3=Medeiros |first3=Felipe A. |date=2014-05-14 |title=The Pathophysiology and Treatment of Glaucoma: A Review |journal=JAMA |language=en |volume=311 |issue=18 |pages=1901–1911 |doi=10.1001/jama.2014.3192 |pmid=24825645 |pmc=4523637 |issn=0098-7484}}</ref><ref name=":3">{{Cite journal |last1=Schuster |first1=Alexander K. |last2=Erb |first2=Carl |last3=Hoffmann |first3=Esther M. |last4=Dietlein |first4=Thomas |last5=Pfeiffer |first5=Norbert |date=2020-03-27 |title=The Diagnosis and Treatment of Glaucoma |journal=Deutsches Ärzteblatt International |volume=117 |issue=13 |pages=225–234 |doi=10.3238/arztebl.2020.0225 |pmid=32343668 |pmc=7196841 |issn=1866-0452}}</ref>

Prostaglandin analogues, such as [[latanoprost]], [[bimatoprost]] and [[travoprost]], reduce the IOP by increasing the aqueous fluid outflow through the draining angle. It is usually prescribed once daily at night. The systemic side effects of this class are minimal. However, they can cause local side effects including redness of the conjunctiva, change in the iris color and eyelash elongation.<ref name=":4" /><ref name=":3" />

There are several other classes of medications that could be used as a second-line in case of treatment failure or presence of contraindications to prostaglandin analogues.<ref>{{Cite journal |last1=Wagner |first1=Isabella V. |last2=Stewart |first2=Michael W. |last3=Dorairaj |first3=Syril K. |date=December 2022 |title=Updates on the Diagnosis and Management of Glaucoma |journal=Mayo Clinic Proceedings: Innovations, Quality & Outcomes |language=en |volume=6 |issue=6 |pages=618–635 |doi=10.1016/j.mayocpiqo.2022.09.007|pmid=36405987 |pmc=9673042 }}</ref><ref name=":3" /> These include:

* Topical [[beta-adrenergic receptor antagonists]], such as [[timolol]], [[levobunolol]], and [[betaxolol]], decrease aqueous humor production by the epithelium of the [[ciliary body]].
* [[Alpha2-adrenergic agonist]]s, such as [[brimonidine]] and [[apraclonidine]], work by a dual mechanism, decreasing aqueous humor production and increasing uveoscleral outflow.
* Less-selective [[Alpha-adrenergic agonist|alpha agonists]], such as [[epinephrine]], decrease aqueous humor production through vasoconstriction of ciliary body blood vessels, useful only in open-angle glaucoma. Epinephrine's mydriatic effect, however, renders it unsuitable for closed-angle glaucoma due to further narrowing of the uveoscleral outflow (i.e. further closure of trabecular meshwork, which is responsible for absorption of aqueous humor).
* [[Miosis|Miotic agents]] ([[parasympathomimetic]]s), such as [[pilocarpine]], work by contraction of the [[ciliary muscle]], opening the [[trabecular meshwork]] and allowing increased outflow of the aqueous humour. [[Echothiophate]], an acetylcholinesterase inhibitor, is used in chronic glaucoma.
* [[Carbonic anhydrase inhibitors]], such as [[dorzolamide]], [[brinzolamide]], and [[acetazolamide]], lower secretion of aqueous humor by inhibiting carbonic anhydrase in the ciliary body.

Each of these medicines may have local and systemic side effects. Wiping the eye with an absorbent pad after the administration of eye drops may result in fewer adverse effects.<ref name="Xu">{{cite journal | vauthors = Xu L, Wang X, Wu M | title = Topical medication instillation techniques for glaucoma | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 2 | pages = CD010520 | date = February 2017 | pmid = 28218404 | pmc = 5419432 | doi = 10.1002/14651858.CD010520.pub2 }}</ref> Initially, glaucoma drops may reasonably be started in either one or in both eyes.<ref name="BMC Ophthalmol">{{cite journal | vauthors = Leffler CT, Amini L | title = Interpretation of uniocular and binocular trials of glaucoma medications: an observational case series | journal = BMC Ophthalmology | volume = 7 | pages = 17 | date = October 2007 | pmid = 17916260 | pmc = 2093925 | doi = 10.1186/1471-2415-7-17 | doi-access = free }}</ref>

==== Adherence ====
Poor [[Adherence (medicine)|compliance with medications]] and follow-up visits is a major reason for treatment failure and disease progression in glaucoma patients. Poor adherence could lead to increased complication rates, thus increasing the need of non-pharmacological interventions including surgery. Patient education and communication must be ongoing to sustain successful treatment plans for this lifelong disease with no early symptoms.<ref>{{Cite journal |last1=Quaranta |first1=Luciano |last2=Novella |first2=Alessio |last3=Tettamanti |first3=Mauro |last4=Pasina |first4=Luca |last5=Weinreb |first5=Robert N. |last6=Nobili |first6=Alessandro |date=October 2023 |title=Adherence and Persistence to Medical Therapy in Glaucoma: An Overview |journal=Ophthalmology and Therapy |language=en |volume=12 |issue=5 |pages=2227–2240 |doi=10.1007/s40123-023-00730-z |pmid=37311908 |pmc=10441906 |issn=2193-8245}}</ref>