Travoprost

How it works

It is a selective prostaglandin F2-alpha receptor agonist that reduces intraocular pressure mainly by increasing uveoscleral outflow of aqueous humour.

Prescribing in practice

• Patients should be counselled that it can cause gradual and often permanent increased brown iris pigmentation, periocular skin darkening and increased eyelash growth, which is most apparent when only one eye is treated.
• Use with caution in patients at risk of intraocular inflammation or macular oedema, including those with active uveitis or aphakia.
• Avoid skin contact with the drop, as periocular pigmentation and hair growth can occur where it runs onto the skin.

Monitoring

Monitor intraocular pressure to confirm response and review periodically for iris and periocular pigmentary changes and ocular surface tolerability.

Counselling the patient

• Instil once daily, usually in the evening, and continue regularly even without symptoms.
• Iris colour, eyelid skin and eyelashes may darken or change and this can be permanent.
• Wipe away any excess from the skin and expect brief blurring after instillation.

Evidence & guidelines

Prostaglandin analogues such as travoprost are recommended by NICE as a first-line option for lowering intraocular pressure in open-angle glaucoma and ocular hypertension.