EFFECT OF NASOLACRIMAL OCCLUSION ON DOSE AND DURATION OF ACTION OF TOPICAL OCULAR HYPOTENSIVE AGENTS

The effects of nasolacrimal occlusion (NLO) on the therapeutic index o f various antiglaucoma medications were assessed in normal volunteers and patients with primary open-angle glaucoma (POAG). Use of NLO impro ved efficacy and safety. NLO used with 2% pilocarpine, 1.5% carbachol, 0.25% timolol maleate, and 1% epinephrine every 12 hours led to the m aximal response for these drugs. A twice-daily application of 0.25% ti molol and 1.5% carbachol gave the maximal response for this combinatio n. NLO did not alter the effect of 0.1% dipivefrin, and 0.05% dipivefr in, every 12 hours, might be an adequate dosage for maximal effect. Ou r findings suggest that most of the commercially used antiglaucoma age nts can reach the maximal effect with lower concentrations and less fr equent administration (never exceeding every 12 hours). NLO should mar kedly decrease systemic absorption and side effects following topical treatment.