Prostaglandin Analogues for Glaucoma: Uses, Mechanism, and Safety Guide

Glaucoma is a leading cause of irreversible blindness worldwide. Effective control of intraocular pressure (IOP) remains the mainstay of treatment. Among the available options, prostaglandin analogues are considered the first-line therapy for primary open-angle glaucoma and ocular hypertension. 

🔬 What Are Prostaglandin Analogues? 

Prostaglandin analogues are ophthalmic drugs derived from prostaglandin F₂α. They lower intraocular pressure by increasing the natural drainage of aqueous humor from the eye. These agents are typically administered once daily at bedtime, making them convenient for long-term use. 

🧬 Mechanism of Action 

Prostaglandin analogues increase uveoscleral outflow of aqueous humor through the ciliary muscle. 

• Result: Decrease in intraocular pressure. 

• Clinical importance: Prevents optic nerve damage and preserves vision in glaucoma patients. 

💊 Commonly Used Prostaglandin Analogues 

These drugs are widely available as topical eye drops: 

• Latanoprost 

• Travoprost 

• Bimatoprost 

• Tafluprost 

Each is applied once daily at night, providing sustained IOP reduction with minimal systemic absorption. 

✅ Therapeutic Uses 

• Primary Open-Angle Glaucoma: First-line treatment option. 

• Ocular Hypertension: Reduces elevated IOP to prevent progression to glaucoma. 

⚠️ Adverse Effects 

While effective, prostaglandin analogues may cause mild to moderate ocular side effects: 

• Iris pigmentation (may darken light-colored eyes) 

• Eyelash growth and thickening 

• Conjunctival redness 

• Periorbital darkening 

• Mild irritation or discomfort 

These effects are usually localized and reversible after discontinuation. 

🚫 Contraindications 

Use with caution in: 

• Patients with history of uveitis or iritis (can worsen inflammation) 

• Pregnancy (risk–benefit should be evaluated) 

• Hypersensitivity to prostaglandins or formulation components 

💊 Drug Interactions 

• Other prostaglandin analogues: May paradoxically increase IOP if combined. 

• Ophthalmic NSAIDs: Can reduce therapeutic efficacy. 

• Steroid eye drops: May counteract pressure-lowering effects. 

💡 Clinical Tips for Safe Use 

• Apply once daily at bedtime. More frequent use reduces effectiveness. 

• Remove contact lenses before use and reinsert after 15 minutes. 

• Press nasolacrimal duct (corner of the eye) for 1–2 minutes after instillation to minimize systemic absorption. 

• Monitor iris color and eyelid skin regularly during therapy. 

📈 Key Takeaway 

Prostaglandin analogues remain the cornerstone of glaucoma therapy due to their strong efficacy, once-daily dosing, and favorable safety profile. Regular monitoring and patient education improve adherence and long-term outcomes.