Side effects eyedrops

There are four major classes of pressure lowering drops: 

1. prostaglandin analogues 
2. beta-blockers
3. alpha-agonists
4. topical carboanhydrase inhibitors 

Prostaglandin analogues

Prostaglandin analogues are often the first choice to treat chronic open-angle glaucoma because of their excellent pressure lowering effect and the low prevalence of systemic side effects (Latanoprost, Tafluprost, Travoprost, Bimatoprost).  

Beta-blockers

Beta-blockers are an alternative choice as first line therapy. However, their pressure lowering effect is slightly inferior to that of prostaglandin analogues and they are contra-indicated in a number of systemic conditions: asthma, history of COPD, sinus bradycardia, heart block or cardiac failure (timolol, levobunolol, metipranolol, carteolol, betaxolol).

Alpha-agonists

Alpha-agonists are less often prescribed due to the high incidence of topical allergic reactions (brimonidine, apraclonidine). They are contra-indicated in patients on MAO-inhibitors. 

Carboanhydrase inhibitors 

Finally, there is the group of topical carbonic anhydrase inhibitors. Their pressure lowering effect is still weaker than that of beta-blockers, reason why they are often used as adjunctive therapy in combination with either prostaglandine analogues or beta-blockers to obtain an additional intraocular pressure reduction (brinzolamide, dorzolamide). There are no systemic contra-indications