Current management of glaucoma is aimed at establishing and maintaining a target intraocular pressure (IOP) for each patient and prostaglandin analogues are superior to beta-blockers in lowering IOP (25-30% vs. 20-25%).

Patients should be monitored for any changes to eye colouration since an increase in the brown pigment in the iris may occur. Particular care is required in those with mixed coloured iris and those receiving treatment to one eye only. The eyelashes may also to grow longer and increase the degree of skin pigmentation around the eyes. Patients should be counselled regarding this side effect.

Prostaglandin analogues have a comparatively low incidence of reported side effects though uveitis and macular oedema have been reported.

Due to the increased cost preservative-free preparations should only be used in patients who have a proven sensitivity to preservatives. For further information please see Administration of drugs to the eye

If prostaglandin analogues are used more frequently than the licensed once daily dose, this can cause the IOP to rise. One bottle is designed to last for 28 days when used in either one or both eyes.

Although all treatments for glaucoma are listed as specialist initiated drugs it is expected that the first-line treatment to be with generic latanoprost.

Where patients require treatment with a prostaglandin analogue and a beta blocker or a sympathomimetic, combination products may be used if this will aid compliance and may be useful in patients with poor manual dexterity, and patients who experience local irritation due to increased exposure to preservatives.

Monotherapy eye preparations

Latanoprost

• Eye drops 50micrograms/ml (£1.92 = 2.5ml)
• Single unit dose eye drops 50micrograms/ml (preservative free) (£8.49 = 30 x 0.2ml, £25.47 = 90 x 0.2ml)

Dose

• Apply once daily, preferably in the evening

Travoprost

• Eye drops 40micrograms/ml (£1.99 = 2.5ml)

Dose

• Apply once daily, preferably in the evening

Bimatoprost

• Eye drops 100micrograms/ml (£4.99 = 3ml)
• Single unit dose eye drops 300micrograms/ml (preservative free) (£12.44 = 30 x 0.4ml)

Dose

• Apply once daily, preferably in the evening

Tafluprost

• Single unit dose eye drops 15micrograms/ml (preservative free) (£12.20 = 30 x 0.3ml)

Dose

• Apply once daily, preferably in the evening

Combination eye preparations including timolol

Latanoprost/ Timolol

• Eye drops latanoprost 50micrograms/ml / timolol 5mg/ml (£4.75 = 2.5ml)
• Single unit dose eye drops latanoprost 50micrograms/ml / timolol 5mg/ml (preservative free) (£13.49 = 30 x 0.2ml)

Dose

• Apply once daily, preferably in the evening

Travoprost/ Timolol

• Eye drops travoprost 40micrograms/ml / timolol 5mg/ml (£5.02 = 2.5ml)

Dose

• Apply once daily, preferably in the evening

Bimatoprost/ Timolol

• Eye drops bimatoprost 300micrograms/ml / timolol 5mg/ml (£10.16 = 3ml)
• Single unit dose eye drops bimatoprost 300micrograms/ml / timolol 5mg/ml (preservative free) (£17.94 = 30 x 0.4ml)

Dose

• Apply once daily, preferably in the evening

Tafluprost/ Timolol

• Single unit dose eye drops tafluprost 15micrograms/ml / timolol 5mg/ml (preservative free) (£14.50 = 30 x 0.3ml)

Dose

• Apply once daily

Combination eye preparations without timolol

Latanoprost / netarsudil

• Eye drops latanoprost 50 microgram/ml / netarsudil 200 microgram/ml (£10.00 = 2.5ml)

Indication

• Primary open-angle glaucoma or ocular hypertension in adults in line with TA1009 (see note 2)

Dose

• Apply once daily, preferably in the evening

Notes

1. Due to netarsudil's vasodilating properties, other eye drops should be administered before latanoprost-netarsudil. Eye ointments should be administered last.
2. NICE TA1009 (October 2024): Latanoprost–netarsudil is recommended as an option for reducing intraocular pressure (IOP) in adults with primary open-angle glaucoma or ocular hypertension when a prostaglandin analogue alone has not reduced IOP enough, only if:
   1. they have then tried a fixed-dose combination treatment and it has not reduced IOP enough, or
   2. a fixed-dose combination treatment containing beta-blockers is unsuitable.