[Treatment of glaucoma]

Glaucoma is a group of chronic and evolutive optic neuropathies. It is caracterised by a progressive loss of optic nerve cells with specific modifications of the optic nerve head and of the visual field. A high intraocular pressure is one of the main risk factors. Thereby, the aim of glaucoma treatment is to reduce the intraocular pressure by medical, physical and/or surgical means. Eyedrops are used as initial treatment. As the most effective drops, prostaglandin analogs are the first-line therapy and have only few systemic side effects. Beta-blockers, local carbonic anhydrase inhibitors and alpha-agonists are the other most employed glaucoma drugs. Pilocarpine, acetazolamide and hyperosmotic agents are used in specific cases. Fixed combinations improve the compliance and the quality of life of patients who need several eyedrops. Preservative-free drops reduce ocular toxicity and improve the compliance of the patients. Trabeculoplasty or trabeculectomy are usefull in case of non response on ocular drops, or if the target pressure is not reached, or when dealing with toxicity or compliance matters. Nevertheless, the first procedure has a time-limited efficiency and the second-one exposes the patient to common surgery-related complications. Therefore, despite good results, they are rarely proposed as first-line therapy.