Glaucoma Adjunct Therapy – What Works With Your Main Drops?

Glaucoma usually needs more than one medicine to keep eye pressure down. If your first eye drops aren't enough, doctors add an "adjunct" – another drug that works in a different way. The goal is simple: protect the optic nerve and keep your vision safe without adding too many side effects.

Before you think about extra drops, know why they matter. Eye pressure (IOP) can still rise even when you use prostaglandin analogues, the most common first‑line meds. Adding a second drug can cut that pressure further, sometimes by another 20‑30 %. That extra drop can mean the difference between stable vision and progressive loss.

Common Adjunct Options

Here are the main adjuncts you’ll hear about:

• Beta‑blockers (e.g., timolol): Reduce fluid production. Works well with prostaglandins but may affect heart rate, so check with your GP if you have asthma or heart issues.
• Carbonic anhydrase inhibitors (e.g., dorzolamide, brinzolamide): Cut fluid formation through a different pathway. Often given as eye drops, sometimes as pills when drops aren’t enough.
• Alpha agonists (e.g., brimonidine): Both lower fluid production and increase outflow. Can cause a dry mouth or fatigue, so use cautiously if you’re driving.
• Rho‑kinase inhibitors (e.g., netarsudil): Newer class that opens drainage channels. Works nicely with older drugs and may help people who can’t tolerate beta‑blockers.
• Combination drops: Many brands mix two agents in one bottle (e.g., latanoprost‑timolol). Fewer bottles mean easier schedules, but watch for side‑effects from both ingredients.

These options are not one‑size‑fits‑all. Your eye doctor will pick based on your IOP reading, other health conditions, and how well you tolerate the first drop.

Safe Use and Monitoring

Adding an adjunct means more appointments. Your doctor should check your IOP about a month after the new drop starts, then every three to six months. If you notice red eyes, stinging, or changes in vision, call the clinic right away. Some drugs can affect the heart or lungs, so tell your doctor about any chronic illnesses.

Stick to the schedule. Missing doses lets pressure creep up, and the benefit of two drugs together disappears fast. If a drop feels uncomfortable, try putting it in the lower eyelid pouch and close your eye gently for a minute – that can reduce splash and irritation.

Lifestyle tweaks can boost the effect of medicines, too. Regular exercise, a balanced diet low in salt, and staying hydrated help the eye’s fluid balance. Some people find that omega‑3 supplements or green‑tea extract have a mild pressure‑lowering effect, but they’re not a replacement for drops.

Remember, adjunct therapy is a partnership between you and your eye team. Keep a simple log of each drop, the time you use it, and any side effects. Bring that list to every visit – it makes the doctor’s job easier and keeps your eyes safer.

Bottom line: if your first eye drop isn’t keeping the pressure where it should be, an adjunct can fill the gap. Talk to your optometrist or ophthalmologist, pick the right combo, and stay on top of monitoring. Your vision is worth the extra effort.