A review of drug-induced acute angle closure glaucoma for non-ophthalmologists

Abstract

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Several types of drugs have the potential to precipitate acute angle closure glaucoma. These include adrenergic, cholinergic and anticholinergic, antidepressants, anticoagulants and sulfa-based agents. This article provides a basic overview of the risk factors and pathophysiologic mechanisms involved in angle closure glaucoma and focuses on drug-induced angle closure glaucoma for the non-ophthalmologist. A PubMed search limited to the English language was conducted to find relevant literature for the purpose of this article. Most attacks occur in subjects unaware that they are at risk due to innately narrow iridocorneal angles. Clinicians should always review medications in patients presenting with symptoms of acute angle closure glaucoma. The aim of this article is to bring this ophthalmic condition to the attention of clinicians, particularly those outside the field of ophthalmology who commonly prescribe these medications or see these patients prior to referring to ophthalmologists.

Acetylcholine decreases formation of myofibroblasts and excessive extracellular matrix production in an in vitro human corneal fibrosis model

“…Moreover, it seems that the kinetically energized ultra–low‐dose ACh is safe for topical applications to skin in pre‐clinical studies, which would be very promising and beneficial for treating corneal wounds. Additionally, it might be interesting to study whether application of anti‐cholinergic drugs such as tropicamide, atropine or cyclopentolate, which are commonly administered for the purpose of ocular examination in order to dilate the pupil, or application of cholinergic drugs such a pilocarpine, which is used to constrict the pupil in the treatment of angle closure glaucoma, will have a negative or positive effect, respectively, on persons with wounded corneas.…”

Single Dose of Pseudoephedrine Induces Simultaneous Bilateral Acute Angle Closure Crisis

“…Acute angle closure crisis (AACC) is a sight-threatening ocular emergency. It typically presents as acute unilateral ocular/periocular pain and headache with rapidly progressive visual loss, sometimes associated with nausea and vomiting [1]. Examination of the affected eye typically reveals a mid-dilated unreactive or sluggish pupil, ciliary injection, a shallow anterior chamber, markedly reduced visual acuity (6/60 to hand motion), markedly raised intraocular pressure (above 50 mm Hg), and corneal haze due to corneal oedema [1].…”

“…It typically presents as acute unilateral ocular/periocular pain and headache with rapidly progressive visual loss, sometimes associated with nausea and vomiting [1]. Examination of the affected eye typically reveals a mid-dilated unreactive or sluggish pupil, ciliary injection, a shallow anterior chamber, markedly reduced visual acuity (6/60 to hand motion), markedly raised intraocular pressure (above 50 mm Hg), and corneal haze due to corneal oedema [1]. AACC occurs due to occlusion of the trabecular meshwork by the peripheral iris, thus preventing outflow of aqueous humour from the anterior chamber of the eye [1].…”

“…Examination of the affected eye typically reveals a mid-dilated unreactive or sluggish pupil, ciliary injection, a shallow anterior chamber, markedly reduced visual acuity (6/60 to hand motion), markedly raised intraocular pressure (above 50 mm Hg), and corneal haze due to corneal oedema [1]. AACC occurs due to occlusion of the trabecular meshwork by the peripheral iris, thus preventing outflow of aqueous humour from the anterior chamber of the eye [1]. This occlusion may be precipitated by a medication (typically a mydriatic) in an individual with ocular anatomy that predisposes them to AACC.…”

“…Anatomical risk factors include having a small anterior segment (commonly seen in hypermetropes) and a crowded anterior segment which is usually due to an enlarged crystalline lens through normal ageing or cataract [2]. AACC is more prevalent in women and in East Asian and Inuit populations relative to Caucasian populations [1, 2, 3].…”