Douglas J. Rhee, MD

3. For initial medical treatment, we use oral acetazolamide 5–10 mg/kg/dose TID-QID (for preparation instructions, see Appendix2). This may be supplemented with timolol alone 1 or with timolol and pilocarpine 2% 2 ; in patients younger than 2 years ofage, consider using 0.25% timolol rather than 0.5% to limit systemic adsorpsion Topical dorzolamide TID is also well toleratedin patients less than 6 years of age. 3 Brimonidine should be avoided in children particularly those less than 20 kg in bodyweight and younger than 6 years 4 ; apnea has been reported. 54. Consultation with either an ophthalmologist specializing in either pediatrics or glaucoma is recommended.(2) Elevated Eye Pressure During PregnancyNotes: 1. All medications have the potential to cause embryonic and fetal harm and should be used with extreme caution and underthe supervision of a glaucoma specialist whenever possible.2. In general, the IOP lowers during pregnancy. 63. Argon laser trabeculoplasty or selective laser trabeculoplasty can be considered first line treatments despite the lower potentialfor success. If possible, selective laser trabeculoplasty is favored since postsurgical anti-inflammatories should be avoided.4. If laser trabeculoplasty fails, cyclophotocoagulation 7 or medical management should be carefully weighed. TrabeculectomyWITHOUT antimetabolites or postoperative antiinflammatories can also be considered.5. Brimonidine is classified as category B, however, stop brimonidine within one month of delievery. Other antiglaucomamedications are generally classified category C.6. Oral acetazolamide has been reported to be safe in a small case series for the treatment of intracranial hypertension, 8 thustopical carbonic anhydrase inhibitors may be safe. However, acetazolamide during late pregnancy has been associated withrenal tubular acidosis in the newborn and may have potential teratogenic effects if administed during the first 12 weeks offetal development. 97. Prostaglandin analogues should be AVOIDED. Antimetabolites should be AVOIDED.Antiglaucoma Agents 65