Choosing the Right Glaucoma Eye Drops: A Guide for Patients

Issues related to glaucoma?

Hello, Director Gao: During my recent visit to the doctor, I was given two options to choose from: 1.
Shulutong (Brimonidine) 2.
Shuer Tan (Apraclonidine).
I would like to ask the doctor which one I should choose.
I found information online about the side effects of Shuer Tan, which include deepening of iris and eyelid color, lengthening of eyelashes, darkening of the skin around the eyes, macular edema, and iritis.
Recent studies have shown that it can cause fat loss around the orbit, leading to upper and lower eyelid drooping, which can affect vision.
I would like to ask the doctor: Does Shuer Tan cause eyelid drooping? My background information is as follows: my right retina is very thin and close to breaking, I had laser treatment for a hole in my left retina at the end of August 2020, and my right eye has myopia of -10.50 with astigmatism of -1.25, while my left eye has myopia of -9.25 with astigmatism of -2.50.
I would like to ask the doctor: What negative effects could Shuer Tan and Shulutong have on my retina? I have read articles stating that glaucoma eye drops can cause cataracts.
I would like to ask the doctor: Do Shuer Tan and Shulutong cause cataracts? Additionally, if a retinal detachment occurs after midnight when the doctor is off duty, on weekends, national holidays, or during long holidays like the Lunar New Year, where should I go for medical attention? How should I handle an emergency? Thank you, doctor, for taking the time to respond to my inquiries amidst your busy schedule.
I am very grateful.
Here is the link to my previous consultation with Director Gao: https://adoctor.tw/article/164794 [email protected].
The consultation number is #164794.

Ping An, 40~49 year old female. Ask Date: 2021/01/25

Dr. Gao Pilin reply Ophthalmology

Hello,
These two medications are completely different and have different effects, so they should be selected based on clinical needs.
I cannot provide specific recommendations.
However, it is generally uncommon to use Shulutong alone.
The likelihood of these two medications causing cataracts is very low.
The side effects of Suratan include darkening of the iris and eyelid color, lengthening of eyelashes, and darkening of the skin around the eyes.
Eyelid ptosis is rare.
There is minimal impact on the retina.
Major hospitals have ophthalmology departments in their emergency rooms, with attending physicians on duty, so you can seek care at the emergency department first.

In Taiwan, the ophthalmology department at Puzi Hospital is available:
Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 2:00 PM to 4:30 PM.

Online responses can only serve as a reference; if necessary, it is still important to seek care at a medical facility.
I hope to have the opportunity to serve you.

Gao Pilin

Reply Date: 2021/01/25

More Info

When it comes to choosing the right glaucoma eye drops, it's essential to understand the specific medications available and their potential side effects, especially given your unique medical history. You mentioned two options: 舒露瞳 (Shu Lu Tong) and 舒而坦 (Shu Er Tan). Let's break down these options and address your concerns.

Understanding the Medications
1. 舒露瞳 (Shu Lu Tong): This medication typically contains latanoprost, which is a prostaglandin analog. It works by increasing the outflow of aqueous humor from the eye, thereby lowering intraocular pressure (IOP). Common side effects may include changes in eye color, eyelash growth, and potential darkening of the skin around the eyes.

2. 舒而坦 (Shu Er Tan): This medication usually contains timolol, a beta-blocker that reduces the production of aqueous humor. Side effects can include fatigue, dizziness, and respiratory issues, particularly in patients with asthma or other respiratory conditions. You mentioned concerns about side effects such as eyelid drooping and changes in the appearance of the eyes, which have been reported in some cases.

Side Effects and Concerns
Regarding your specific questions:
- Will Shu Er Tan cause eyelid drooping? While eyelid drooping (ptosis) is not a common side effect of timolol, individual reactions can vary. If you notice any changes in your eyelids or vision, it's crucial to discuss this with your ophthalmologist.

- Impact on the retina: Both medications primarily target intraocular pressure and are not directly associated with retinal damage. However, given your history of retinal issues, it’s essential to monitor any changes in your vision closely. Regular follow-ups with your eye doctor are crucial.

- Risk of cataracts: There is some evidence suggesting that long-term use of certain glaucoma medications, particularly corticosteroids, can increase the risk of cataracts. However, neither latanoprost nor timolol is primarily associated with cataract formation. Still, it's wise to discuss this with your doctor, especially considering your existing retinal concerns.

Emergency Situations
In the event of a retinal detachment, immediate medical attention is necessary. If this occurs outside of regular office hours, you should go to the nearest emergency room. Many hospitals have ophthalmology on call, and they can provide the necessary care. It's advisable to familiarize yourself with the emergency protocols at your local hospital, especially during holidays or weekends.

Conclusion
Choosing between Shu Lu Tong and Shu Er Tan should be based on a thorough discussion with your ophthalmologist, considering your medical history and the potential side effects of each medication. If you have concerns about side effects or interactions with your existing conditions, do not hesitate to bring these up with your doctor. They can provide personalized advice and may suggest alternative treatments if necessary.

In summary, both medications have their benefits and risks, and the choice should align with your specific needs and medical history. Regular monitoring and open communication with your healthcare provider are key to managing your glaucoma effectively.

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