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Thursday 29 September 2016 Instagram
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‘I don’t do glaucoma’

‘I don’t do glaucoma’

International Glaucoma Association
Woodcote House,
15 Highpoint Business Village, Henwood, Ashford, Kent
TN24 8DH
T: 01233 648164
Sightline (helpline): 01233 64 81 70
(Mon-Fri, 9.30am-5.00pm)

Patients with glaucoma usually do not suffer from visual symptoms and are treated with eye drops. But is it really that simple? And why do primary care nurses need to know about it?

'I don't do glaucoma' or 'I don't do eyes' are statements we hear often from nurses walking past our stand at the Royal College of Nursing conference. On the face of it, that is probably true (unless they are rushing to get a coffee during a break in presentations); but the fact is that we really don't need to speak to those who do eyes – we need to speak to all of you who don't. Here's why.

Thinking about glaucoma; if it is managed well, it is an almost invisible condition – yet it affects about 2% of the population over the age of 40. Patients can usually see quite well, so there is no visual impairment clue and the treatment is by eye drops that take 'just a blink of the eye' to instil and, likewise, just a 'blink of the eye' to miss. So, if there aren't any visual symptoms and the treatment is just with eye drops, why is it important for you to know about glaucoma?

To state the obvious, eye drops are drugs too, but unlike tablets or injections, they are often thought of as innocuous by patients and healthcare professionals alike. Unfortunately, they are anything but and they can cause very serious systemic side-effects that can even be life threatening. As far back as 1995 Dr Paul Diggory, a geriatrician at Mayday Hospital in Croydon was publishing damning evidence about the cardio-pulmonary effects of beta blocker eye drops used in the treatment of glaucoma. Shortness of breath is not necessarily a function of old age, or of asthma; yet it is known from analysis of prescriptions that there are a significant number of people being prescribed both beta blocker eye drops and broncho dilators at the same time!

There are five main classes of glaucoma eye drops, each of which has its own positives and negatives, but any or all of which could be affecting a patient under your care. After all, one person in 50 over the age of 40 has glaucoma. The classes of drops are:

  • Alpha 2 agonists whose non-ocular side-effects include headaches, drowsiness, dizziness, taste disturbance, upper respiratory symptoms, dry mouth, GI upset, fatigue and asthenia.
  • Beta blockers whose non-ocular side-effects include bradycardia, chest pain, AV block,palpitations, bronchospasm, dyspnoea, skin disorders, headache, malaise, dizziness, nausea, sinusitis and depression.
  • Carbonic anhydrase inhibitors whose non-ocular side-effects include bitter taste, local irritation, headache, asthenia, nausea, urolithiasis, hypersensitivity, flushing, thirst, drowsiness, polyurea, paraesthesia, blood dyscrasias, rash and metabolic acidosis.
  • Miotics (rarely prescribed) whose non-ocular side-effects include headache and brow ache.
  • Prostaglandin/prostamides whose non-ocular side-effects include headache, raised liver enzymes and hypertension.

Of course, no one would expect a non-specialist nurse to remember all of these potential side-effects, but we would like you to remember that glaucoma eye drops can cause a wide variety of problems that often go beyond local ocular problems and affect the whole system. The situation is complicated by the fact that most glaucoma patients require more than one class of eye drops to maintain a safe level of intraocular pressure and that some of the drugs can be supplied in fixed combinations (two drugs in one drop).

The story of why you do eyes can go much further, especially when your patient has other conditions with which to contend. If someone has reduced mobility or dexterity that makes it more difficult for them to instil their eye drops this, too, is an important complicating factor in a treatment plan because, even though glaucoma is a slowly progressive condition, every time a drop is missed it is probable that a small part of their field of vision will be lost. These losses are cumulative because it is impossible to regain any vision lost to glaucoma and, over time, this can lead to a significant loss of quality of life and independence.

If you would like further information about any aspect of glaucoma or free supplies of information for your patients or practice, please visit our website: or contact us by phone on 01233 64 81 70 or by email at

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