NHMRC Glaucoma Guidelines - ANZGIG

NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA
Chapter 9 – Medication
Care must be taken in instilling topical ophthalmic medications to children. This is due to higher
absorption, greater circulating concentrations (due to reduced blood volumes), and immature
metabolic pathways increasing the half-life for elimination. Moreover medications are generally only
available in adult dosages. To limit potential adverse effects, it is important to adhere to dosage
times, use nasolacrimal system occlusion (if at all possible in small children) and use the minimum
dose or limit the number of medications required.
Treatment of children with glaucoma requires specialist consultation. While medications used in
the treatment of glaucoma may not be licensed for use in children, many of them can be used
safely. Topical medication is generally well tolerated however there are some notable exceptions.
Table 9.7 provides an overview of the different medication options and special notes for their use
in children. In particular, the central nervous system depressant effects of alpha2-agonists should
not be underestimated.
It is essential that all contraindications, precautions and interactions are taken into consideration
when prescribing anti-glaucoma medications for children, just as for adults. When choosing a
medication, the lowest possible concentration should be used in conjunction with techniques to
reduce systemic absorption to minimse the potential for side effects (see Table 9.8).
Evidence supports the use of topical beta-blockers, carbonic anhydrase inhibitors and prostaglandin
analogues for the treatment of children with glaucoma, but with caution. Alpha2-agonists should
be limited to children older than seven years of age. The alpha2-agonists have more and potentially
serious adverse effects for children and are contraindicated for children younger than two years of age.
Systemic use of carbonic anhydrase inhibitors is usually the last choice of management in situations
where glaucoma is not satisfactorily controlled with other topical medications. They may also be
considered when attempting to avoid/delay surgical intervention and prevent further glaucomatous
optic neuropathy.
130 National Health and Medical Research Council