chronic

Glaucoma (continuing therapy, open-angle)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Latanoprost 50 micrograms/ml Eye Drops Solution SmPC sections 4.2 and 4.4 (eMC product 2983) · Timoptol 0.5% w/v Eye Drops Solution SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10611) · Tripathy K, Zeppieri M. Open Angle Glaucoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan- . [Updated 2024 Mar 7]. Bookshelf ID: NBK441887. PMID: 28722917.

Verified against3 documents

Latanoprost 50 micrograms/ml Eye Drops Solution SmPC sections 4.2 and 4.4 (eMC product 2983)
Timoptol 0.5% w/v Eye Drops Solution SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10611)
Tripathy K, Zeppieri M. Open Angle Glaucoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan- . [Updated 2024 Mar 7]. Bookshelf ID: NBK441887. PMID: 28722917.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

Usually silent early on, which is why history and eye examination matter for picking it up
Peripheral vision goes first and the patient does not notice until about 40% of nerve fibres are lost, when tunnel vision begins
Older people may report trouble driving or bumping into things at home more often
Past eye pain or redness, headaches, or seeing multicoloured halos point towards glaucoma [eye pain · redness]
Field loss follows silent thinning of the nerve fibre layer and cupping of the optic nerve

Signs — what you find (8)

Highest risk when examination shows a bigger cup-disc ratio, asymmetry between the two, disc bleeding, or raised pressure [bleeding]
Looking at the disc gives reliable information because it changes before any field loss is noticed
Thinning of the superior and inferior rim breaks the normal ISNT pattern
Disc findings: cup-disc ratio over 0.5, a taller vertical cup with rim thinning, and 0.2 or more difference between eyes
Bleeding at or beside the disc, and wasting of the tissue around it [bleeding]
The rim stays pink here; a pale rim suggests an atrophic nerve, as in angle closure [atrophy · pallor]
Usually affects both eyes, so the two discs can be compared, though damage may be uneven
Rim notching at the top or bottom of the disc, with a matching wedge-shaped defect in the nerve fibre layer

Tests (12)

The diagnostic triad is disc or nerve fibre layer change, field change, and raised eye pressure
Goldmann applanation tonometry remains the reference method for measuring pressure
Normal pressure sits between 12 and 21 mm Hg; a reliable reading above 21 puts the patient in the glaucoma or ocular hypertension group
Raised pressure is a modifiable risk factor, not by itself a diagnosis
A thick cornea makes the measured pressure read too high, a thin one too low
A gap of 3 mm Hg or more between the two eyes raises suspicion
Gonioscopy separates open from closed angle glaucoma
This is a diagnosis of exclusion, and closed-angle glaucoma has to be ruled out as an ocular emergency
Typical field defects: paracentral scotoma often superonasal, a nasal step, temporal wedge, and arcuate or Bjerrum scotoma
Between 40% and 50% of ganglion cells must be gone before threshold perimetry reliably shows a defect
A field defect counts only if repeatable over at least two tests, ideally on the same machine and protocol
OCT of the retina around the disc can show that the nerve fibre layer has thinned

If not this — what else fits (12)

Physiological cup: deep cup but a healthy rim, normal nerve fibre layer and no field defect
Optic disc drusen
Optic disc coloboma
Anomalous or tilted optic disc
Ischaemic optic neuropathy
Branch retinal vein occlusion
Branch retinal artery occlusion
Retinitis pigmentosa
Previous panretinal photocoagulation
Pituitary tumour: pale rim rather than cupping, and bitemporal hemianopia respecting the vertical meridian
Foster Kennedy syndrome
Multiple sclerosis

SourceStatPearls "Open Angle Glaucoma" - disease-level clinical article

Presentation findings are traced to the source above.

LATANOPROST

1st line

Formeye

Adult dose and duration

One drop into the affected eye(s) once daily, in the evening. Do NOT exceed once daily - more frequent use lowers the pressure-reducing effect - Long term

Paediatric dose

The label covers paediatric glaucoma, but a child with glaucoma is under ophthalmology and the drop is their decision, not a primary-care one.

Dose source

Latanoprost 50 micrograms/ml Eye Drops Solution SmPC sections 4.2 and 4.4 (eMC product 2983)

Why

A prostaglandin analogue, once daily, and the label states the optimal effect is obtained in the evening. No systemic beta-blockade, which is what makes it the easier drop to repeat in a patient with asthma or heart disease.

Cautions

Diagnosis, target pressure and any change of drug are the ophthalmologist's. This entry is for continuing a drop already started and for the questions that arise between visits.
It permanently darkens the iris in mixed-coloured eyes, usually within the first 8 months. Warn the patient before the first bottle - it is not reversible.
It lengthens, thickens and darkens the eyelashes, and can make them grow in the wrong direction. This one does reverse on stopping.
Contact lenses out before the drop, back in no sooner than 15 minutes - the preservative is absorbed by soft lenses.
Use caution where there is a risk of iritis or uveitis; the label records no experience in active intraocular inflammation.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
LATANOSWIX 50MCG/ML EYE DROPS 2.5 ML	CHEMIPHARM	50.00 EGP
XALATREX 50MCG/ML EYE DROPS 2.5 ML	EIPICO	67.00 EGP
IOPROST 50MCG/ML EYE DROPS 3 ML	ALEXANDRIA > ORCHIDIA	81.00 EGP
IOPROST 50MCG/ML EYE DROPS 30 X 0.2 ML SDU	ORCHIDIA	126.00 EGP
XALATAN 50MCG/ML EYE DROPS 2.5 ML	PFIZER > VIATRIS EGYPT	228.00 EGP

TIMOLOL

2nd line

Formeye

Adult dose and duration

One drop of the 0.25% solution into the affected eye twice daily. If the response is inadequate, one drop of the 0.5% solution into each affected eye twice daily - Long term

Paediatric dose

Not a primary-care decision in a child. Systemic beta-blockade from eye drops is proportionally greater in a small child.

Dose source

Timoptol 0.5% w/v Eye Drops Solution SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 10611)

Why

A topical beta blocker for raised intraocular pressure in ocular hypertension and chronic open-angle glaucoma. The label starts at 0.25% and steps up to 0.5% only if that is not enough - the stronger drop is not the starting drop.

Cautions

THIS IS A BETA BLOCKER AND IT IS ABSORBED SYSTEMICALLY FROM THE EYE. The label states the same cardiovascular and pulmonary reactions seen with oral beta blockers may occur.
CONTRAINDICATED in asthma or a history of asthma, and in severe COPD.
CONTRAINDICATED in sinus bradycardia, sick sinus syndrome, sino-atrial block, second- or third-degree heart block not controlled by a pacemaker, overt cardiac failure and cardiogenic shock.
It can mask the warning signs of hypoglycaemia in a patient on insulin.
Diagnosis, target pressure and any change of drug are the ophthalmologist's. This entry is for continuing a drop already started and for the questions that arise between visits.
In angle-closure glaucoma the label says it must be used with a miotic and not alone.
Press on the inner corner of the eye (nasolacrimal occlusion) or close eyelids for 2 minutes after instillation to reduce systemic absorption.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CUSIMOLOL 0.5% EYE DROPS 5 ML	RAMEDA > ALCON	10.50 EGP
TIMOGEL 0.1% EYE GEL 5 ML	ORCHIDIA PHARMACEUTICAL INDUSTRIES > ORCHIDIA	12.60 EGP
TARGOTIMOL 0.5% EYE DROPS 10*0.4 ML SDU	GLOBAL ADVANCED PHARMACEUTICALS (GAP) > MONOPHARMA PHARMACEUTICALS	18.00 EGP
TIMOLOL MALEATE 0.5% EYE DROPS 5 ML	EIPICO	19.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.