Ophthalmic Beta-Blockers lower pressure in the eye by reducing aqueous production. These drugs are divided into two classes: 1) nonselective beta-blockers (timolol, levobunolol, metipranolol, carteolol); and 2) beta 1 selective (betaxolol).

Carbonic Anhydrase Inhibitors also lower pressure in the eye by decreasing aqueous production. Carbonic anhydrase inhibitors are available as topically (dorzolamide and brinzolamide) or orally (acetazolamide, methazolamide). The topical forms are associated with fewer systemic side-effects than the oral forms and are better tolerated by many patients.

Alpha-Agonists are still another class of medicine that lower pressure primarily by reducing the aqueous production. In addition, they also may have an effect on increasing the rate at which the fluid drains from the eye. The most frequently prescribed drugs in this class are the relatively selective alpha 2 agonists (apraclonidine, brimonidine).

Miotics have been used for over 100 years to lower eye pressure. Miotics decrease IOP by increasing aqueous outflow through the trabecular meshwork. However, because of their ocular adverse effects (increased myopia, eye and brow pain, decreased vision and retinal problems), the use of miotics is declining. Examples of miotics include pilocarpine and carbachol.