Update on the management of glaucoma.

Most cases of chronic open-angle glaucoma can be treated medically. When medical management is ineffective, laser trabeculoplasty is usually performed. If medical management and laser treatment fail, surgery is the next step. Recently, ultrasound has been employed successfully for control of glaucoma when medical, laser, and surgical treatments were not successful. Acute angle-closure glaucoma is an ophthalmic emergency. This condition can be treated at an early stage by relieving the pupillary block with peripheral iridectomy by laser or surgery. Four major classes of drugs are currently used to treat glaucoma: carbonic anhydrase inhibitors, beta adrenergic blockers, parasympathomimetics, and sympathomimetics. Both local and systemic side effects may occur secondary to glaucoma medications and some of these may be severe or even fatal. These adverse reactions are discussed.