Ocular hyperemia associated with topical glaucoma medication: understanding and differentiating clinical appearance...

Adherence to therapy is fundamental for glaucoma management. Side effects of topical intraocular pressure (IOP)-lowering medications must be managed effectively to maintain adherence to the treatment plan and avoid disease progression. Ocular hyperemia is the most common side effect of topical IOP-lowering medications. It develops either as part of the mechanism of action of an IOP-lowering medication, usually requiring no medical intervention, or as a sign of allergy or toxicity, usually requiring intervention. Therefore, differentiating between types of ocular hyperemia is clinically important.

This clinically oriented narrative review explains the various types of topical glaucoma medication-induced ocular hyperemia, describing the underlying causes, mechanisms of development, and areas involved. Five types of ocular hyperemia associated with IOP-lowering medications are described, relating to the effects of preservatives and active ingredients in mono- and combination therapies. Relevant studies were identified through targeted searches of PubMed and Google Scholar, conducted in August 2024.

Clinicians should identify the type and severity of ocular hyperemia related to IOP-lowering medications and, accordingly, remove allergenic or toxic agents from therapy. Patients should be advised to continue treatment if ocular hyperemia is mild, especially if it is an expected side effect of the medication.