Glaucoma is the leading cause of irreversible blindness in Germany and in the world. Due to the multifactorial genesis of the disease, there are multiple therapeutic approaches for preventing its progression. The goal of the commonly used topical glaucoma medication is to reduce the intraocular pressure and therefore prevent further damage to the optic nerve. There are different medications of various pharmacological classes that are intended to reduce intraocular pressure, namely, β-adrenergic antagonists, adrenergic agonists, parasympathomimetic agents, prostaglandin analogues, carbonic anhydrase inhibitors, hyperosmotic agents, and the 2017 U. S. FDA approved Rho kinase inhibitor, Netarsudil.After determining a patient centered target pressure, which depends upon various factors, an individual treatment regimen should be chosen with one or more agents. Although reducing the intraocular pressure remains the main therapeutic focus, there is increasing evidence indicating that oxidative stress also plays a key role in the pathogenesis of the primary open angle glaucoma. Therefore, direct and indirect neuroprotective agents like Magnesium, Coenzym Q10, Ginkgo biloba and others are getting more and more attention. While there is still a need for further clinical trials, these substances are getting more popular as an adjunct in glaucoma therapy.Georg Thieme Verlag KG Stuttgart · New York.