The role of brimonidine in the treatment of open-angle glaucoma.

At present, medical therapy is the first line of attack against primary open-angle glaucoma. beta-blockers, miotics, sympathomimetics, carbonic anhydrase inhibitors, and prostaglandins have been used with varying degrees of success. The alpha 2-agonists, clonidine, apraclonidine, and now brimonidine are powerful inhibitors of aqueous humor production, thereby lowering intraocular pressure (IOP) in these patients. Brimonidine is emerging as a potential first-line therapy for primary open-angle glaucoma, with a peak IOP-lowering efficacy comparable to that of timolol, but without timolol's adverse cardiopulmonary side effects. Brimonidine promises to be an important new drug to help meet the therapeutic challenges faced by ophthalmologists in treating glaucoma.