Home > Formulary : Adult > Chapters > 11. Eye >

BNSSG Adult Joint Formulary

11.6 Treatment of glaucoma

Share Print Feedback

Last edited: 08-02-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

A preservative free option (or single unit dose drops) may be prescribed if available for all formulary products listed if clinically necessary, as an alternative option
Please ensure that all prescriptions for eye drops clearly state the number of drops, into which eye(s), and the frequency of administration

For urgent reduction of intraocular pressure and before surgery, mannitol 20% (up to 500mL) is given by slow intravenous infusion until the intraocular pressure has been satisfactorily reduced.

Please see BNSSG glaucoma prescribing guidelines

Beta-Blockers

Recommended: (TLS Green)

Timolol 0.25% or 0.5% eye drops

Preservative free options are available for those patients who require them, see BNSSG Glaucoma guidelines for further information

Alternatives: (TLS Blue)

Levobunolol 0.5% eye drops

Timolol 0.1% long acting preservative free eye drops (Tiopex^®)

Timolol 0.25% long acting eye solution (Timoptol LA^®)

Timolol 0.5% long acting eye solution (Timoptol LA^®)

N.B. If a long acting beta blocker is required, the most cost-effective is Timolol LA 0.25% and Timolol LA 0.5%

Prostaglandin Analogues and Prostamides

Recommended: (TLS Green)

Latanoprost 50microgram/mL eye drops

Travoprost 40microgram/mL eye drops

Preservative free options are available for those patients who require them, see BNSSG Glaucoma guidelines for further information

Alternatives: (TLS Blue)

Bimatoprost 100microgram/mL and 300microgram/mL eye drops

Specific indication: (TLS Blue)

Tafluprost 15microgram/mL preservative free unit dose eye drops

Only for use in patients that require preservative free drops

Sympathomimetics

Recommended: (TLS Green)

Brimonidine 0.2% eye drops

Carbonic Anhydrase Inhibitors and Systemic Drugs

Recommended: (TLS Green)

Brinzolamide 10mg/mL eye drops

Dorzolamide 2% eye drops

Alternative: (TLS Blue)

Acetazolamide immediate & modified release (oral)

Miotics

Recommended: (TLS Green)

Pilocarpine 1%, 2% or 4% eye drops

Combination Products

Specific indication: (TLS Blue)

Where there are compliance issues

Latanoprost 50micrograms / Timolol 5mg/mL (brands include Xalacom^®)

Travoprost 40 micrograms / Timolol 5mg/mL eye drops (brands include DuoTrav^®)

Brimonidine 0.2% / Timolol 0.5% eye drops (brands include Combigan^®)

Brinzolamide 10mg / Timolol 5mg/mL eye drops (brands include Azarga^®)

Dorzolamide 2% / Timolol 0.5% eye drops

Cosopt iMulti^® (preservative free) is the preferred brand of Dorzolamide/Timolol eye drops
Ensure suitable communication to the patient on use of the bottle and extended 60 day in use expiry

Tafluprost 15micrograms/mL / Timolol 5mg/mL (brands include Taptiqom^®)

1st line compared to bimatoprost 0.03% & timolol 0.5% eye drops

Bimatoprost 0.03% / Timolol 0.5% eye drops (brands include Ganfort^®)

2nd line compared to tafluprost 15micrograms/mL & timolol 5mg/mL Brinzolamide 10mg/mL & Brimonidine 2mg/mL eye drops (Brand - Simbrinza^®)

Others

Specific indication:

Apraclonidine 0.5% eye drops (TLS Amber Specialist Recommended)

Reduction of elevated intraocular pressure for secondary occular hypertension/glaucoma
Indicated for short term use when on maximal therapy and further IOP reduction is required i.e. while awaiting glaucoma surgery

Contact Us

Got a question or comment about the Joint Formulary?

Please use the email address below to contact us and we will endeavour to respond within 2 working days.

BNSSG.formulary@nhs.net

11.6 Treatment of glaucoma

Beta-Blockers

Timolol 0.25% or 0.5% eye drops

Levobunolol 0.5% eye drops

Timolol 0.1% long acting preservative free eye drops (Tiopex®)

Timolol 0.25% long acting eye solution (Timoptol LA®)

Timolol 0.5% long acting eye solution (Timoptol LA®)

Prostaglandin Analogues and Prostamides

Latanoprost 50microgram/mL eye drops

Travoprost 40microgram/mL eye drops

Bimatoprost 100microgram/mL and 300microgram/mL eye drops

Tafluprost 15microgram/mL preservative free unit dose eye drops

Sympathomimetics

Brimonidine 0.2% eye drops

Carbonic Anhydrase Inhibitors and Systemic Drugs

Brinzolamide 10mg/mL eye drops

Dorzolamide 2% eye drops

Acetazolamide immediate & modified release (oral)

Miotics

Pilocarpine 1%, 2% or 4% eye drops

Combination Products

Latanoprost 50micrograms / Timolol 5mg/mL (brands include Xalacom®)

Travoprost 40 micrograms / Timolol 5mg/mL eye drops (brands include DuoTrav®)

Brimonidine 0.2% / Timolol 0.5% eye drops (brands include Combigan®)

Brinzolamide 10mg / Timolol 5mg/mL eye drops (brands include Azarga®)

Dorzolamide 2% / Timolol 0.5% eye drops

Tafluprost 15micrograms/mL / Timolol 5mg/mL (brands include Taptiqom®)

Bimatoprost 0.03% / Timolol 0.5% eye drops (brands include Ganfort®)

Others

Apraclonidine 0.5% eye drops (TLS Amber Specialist Recommended)

Contact Us

Timolol 0.1% long acting preservative free eye drops (Tiopex^®)

Timolol 0.25% long acting eye solution (Timoptol LA^®)

Timolol 0.5% long acting eye solution (Timoptol LA^®)

Latanoprost 50micrograms / Timolol 5mg/mL (brands include Xalacom^®)

Travoprost 40 micrograms / Timolol 5mg/mL eye drops (brands include DuoTrav^®)

Brimonidine 0.2% / Timolol 0.5% eye drops (brands include Combigan^®)

Brinzolamide 10mg / Timolol 5mg/mL eye drops (brands include Azarga^®)

Tafluprost 15micrograms/mL / Timolol 5mg/mL (brands include Taptiqom^®)

Bimatoprost 0.03% / Timolol 0.5% eye drops (brands include Ganfort^®)