Glaucoma

Medication compliance CRITICAL (most important factor in preventing progression): use eye drops exactly as prescribed (many patients skip doses or stop using—leading cause of preventable blindness from glaucoma), set reminders (phone alarms, pill boxes), proper technique (wait 5 min between different drops, close eyes 1-2 min after instilling—increases absorption, reduces systemic side effects), if difficulty affording ($100-300/month some drops): generic options, patient assistance programs, discuss with doctor, Exercise regularly: aerobic exercise (walking, cycling, swimming) lowers IOP 3-5 mmHg acutely and chronically (improves ocular blood flow), 30-45 min 5x/week, Avoid: inverted positions (headstands, downward dog yoga pose, hanging upside down—increases IOP), weightlifting with Valsalva (holding breath, straining—spikes IOP), high-resistance weight training (very heavy weights), tight neckties (restrict jugular venous return—increases IOP), playing wind instruments (increases IOP), scuba diving (pressure changes), Sleeping position: slightly elevated head (pillow—reduces IOP at night), avoid sleeping on side with affected eye down (increases IOP in that eye), Stress management: chronic stress may worsen glaucoma (increases IOP, reduces blood flow), meditation, yoga (avoid inverted poses), Avoid medications that increase IOP: corticosteroids (oral, inhaled, nasal, topical skin—can dramatically increase IOP, develop steroid-induced glaucoma, discuss alternatives with doctor if possible, if necessary monitor IOP closely), antihistamines and decongestants (may trigger angle-closure in susceptible individuals—narrow angles), anticholinergics, topiramate (can cause angle-closure—rare), Regular eye exams: every 3-12 months depending on severity (IOP checks, visual fields annually, OCT annually, optic nerve exam), Glaucoma medications: Prostaglandin analogs (latanoprost, bimatoprost, travoprost—first-line, most effective, lower IOP 25-30%, once daily evening dosing, side effects—iris color change to brown, eyelash growth, redness, stinging), Beta-blockers (timolol, betaxolol—lower IOP 20-25%, twice daily, systemic side effects—bradycardia, bronchospasm, fatigue, contraindicated in asthma, heart block, COPD), Alpha-agonists (brimonidine—lowers IOP 20%, 2-3x/day, side effects—redness, dry mouth, fatigue, allergy common 10-20%), Carbonic anhydrase inhibitors (dorzolamide, brinzolamide—lower IOP 15-20%, 2-3x/day, side effects—stinging, bitter taste, oral form acetazolamide for severe—systemic side effects), Rho kinase inhibitor (netarsudil—newer, lowers IOP 15-20%, once daily, side effects—redness common, subconjunctival hemorrhage), Combination drops (multiple medications in one bottle—improves compliance, Cosopt, Combigan, Simbrinza), Laser treatment (if medications insufficient): Selective Laser Trabeculoplasty (SLT—improves drainage, lowers IOP 20-30%, outpatient, 70-80% success, may need repeat in 2-5 years), Argon Laser Trabeculoplasty (ALT—older, similar to SLT), Laser Peripheral Iridotomy (LPI—for narrow-angle glaucoma, creates hole in iris to improve fluid flow, prevents angle-closure attacks), Surgery (if medications and laser fail): Trabeculectomy (create new drainage channel, very effective 60-80% IOP control, risks—infection, hypotony, cataracts, bleeding), Tube shunt (drainage device, for refractory glaucoma), Minimally invasive glaucoma surgery (MIGS—newer, less invasive, iStent, Xen gel stent, trabectome, lower IOP modestly, fewer complications, for mild-moderate glaucoma), Acute Angle-Closure Glaucoma (EMERGENCY): sudden IOP spike >40-60 mmHg, severe eye pain, headache, nausea, vomiting, blurred vision, halos, red eye—URGENT TREATMENT NEEDED (can cause permanent blindness in hours), treatment: lower IOP immediately (medications IV and topical), laser iridotomy (definitive—prevents recurrence), fellow eye treated prophylactically (high risk).