# Glaucoma (continuing therapy, open-angle) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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. ## Treatment metadata - Latanoprost — eye - Timolol — eye ## Complete treatment card ```text GLAUCOMA (CONTINUING THERAPY, OPEN-ANGLE) 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. Review status: REVIEWED against 3 sources listed above (2026-08) 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 Source StatPearls "Open Angle Glaucoma" - disease-level clinical article Status traced to the source above 1. LATANOPROST [1st line] Adult 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 Peds The label covers paediatric glaucoma, but a child with glaucoma is under ophthalmology and the drop is their decision, not a primary-care one. 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. Caution 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. Egypt 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 > ... 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 2. TIMOLOL [2nd line] Adult 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 Peds Not a primary-care decision in a child. Systemic beta-blockade from eye drops is proportionally greater in a small child. 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. Caution 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. Egypt CUSIMOLOL 0.5% EYE DROPS 5 ML RAMEDA > ALCON 10.50 EGP TIMOGEL 0.1% EYE GEL 5 ML ORCHIDIA PHAR... 12.60 EGP TARGOTIMOL 0.5% EYE DROPS 10*0.4 ML SDU GLOBAL ADVANCED 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)