Page 29 - 21st Century Perspective - Glaucoma Supplement

uveoscleral outflow by potentiating resident extracellular matrix metalloproteinases within the
uveosclera, thus making the tissue more porous, was revolutionary.

Generally, traditional prostaglandins reduce IOP by about 30% and have mild conjunctival

hyperemia as the most common adverse effect. In phase 3 studies on prostaglandins, two things
were learned:

● The drugs perform best when taken in the evening.
● Once-daily dosing is more effective than twice-daily dosing.

Although prostaglandins are best used in the evenings, compliance is enhanced when patients can
most consistently remember to instill them. Therefore, if a patient reports that he or she takes all
medications with breakfast, then the prostaglandin can also be administered at this habituated time.
These medicines work almost as efficiently when taken in the morning, so if this is the time of

greatest likelihood for compliance, then morning dosing is fine.

Although uncommon, patients with hazel-colored irides can sustain generalized darkening of these
tissues, which is usually only a concern when treating patients with unilateral glaucoma. Even more
uncommon is periorbitopathy ​(Figure 17)​, which represents a decrease in the population of adipose
tissues in the orbit, thus causing a deepening of the superior sulcus, and occasionally an

enophthalmic appearance. When reflected against their sight-saving benefits, these adverse effects
are relatively inconsequential.

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