Alpha agonists are a first/second line treatment.

• A. First
• B. Third
• C. Second
• D. Not used

Answer: (C)

Alpha-2 adrenergic agonists are typically used as a second-line option. They lower intraocular pressure by reducing aqueous humor production and, to a lesser extent, increasing outflow. They’re placed after first-line therapies (usually prostaglandin analogs) because of systemic and local side effects such as dizziness, fatigue, hypotension, dry mouth, and conjunctival redness, as well as the potential for tachyphylaxis with long-term use. These drawbacks make them less favorable as initial therapy, but they remain valuable as add-on or alternative therapy when target pressure isn’t reached with first-line treatment. They are not considered not used or third-line in most practice guidelines.