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Glaucoma is an increase in the IOP- intraocular pressure. There are various causes of glaucoma. In purebred dogs this is usually primary glaucoma – ie an abnormal drainage angle is a cause without other diseases. There is also secondary glaucoma ie with other diseases most commonly secondary to uveitis – inflammation.
So the best glaucoma drop to use depends on the primary cause.
For primary glaucoma – ie no other disease eg uveitis or lens luxation – then the prostanoids eg Latanoprost or Travatan are the go-to drugs. They usually work within 90 minutes. However, in some cases, these drugs may only work for 4 to 6 weeks. In some cases, we swap between the Latanoprost and the Travatan. These drops are normally used two to three times daily.
In primary glaucoma we would also use a topical carbonic anhydrase inhibitor (CAI), these work through a different pathway so are additive to the prostanoids.
REMEMBER that in primary glaucoma the other eye will be predisposed, in such a case we would do gonioscopy to check the drainage angle – if the drainage angle is abnormal we would use a topical CAI e.g. Cosopt ( dorzolamide and timolol) or Azarga (brinzolamide/timolol) 2 times daily.
For secondary glaucoma, we would use a topical CAI e.g. Cosopt ( dorzolamide and timolol) or Azarga (brinzolamide/timolol) three times daily.
In my experience, I do not find Timolol strong enough in dogs and cats with glaucoma.
There are no combinations that you cannot use.
In my experience, Alphagan and Glanatec are not used in animals.
Remember that glaucoma in cats is most commonly secondary to uveitis. So in these cases, I will use a topical CAI without timolol eg Trusopt (dorzolamide) for Azopt (brinzolamide)