Angle closure risk from proprietary medicines

Barrett, Victoria; Jordan, Tim

doi:10.1038/eye.2001.82

Cited by 12 publications

(8 citation statements)

References 1 publication

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“…Additionally, there is some suggestion that cold and flu medication containing strong nasal decongestants may increase risk, although it is unclear if this is association or causation. [49][50][51] People who make regular, long-haul air journeys, and those who live or work in remote regions of the world where emergency ophthalmic care is not available may be reassured by undergoing prophylactic laser iridotomy. 52 However, until evidence becomes available to the contrary, the widespread practice of identifying people with narrow angles and no other risk factors, and encouraging laser iridotomy is not supported by evidence.…”

Section: Laser Iridotomy Should Continue To Be Discussed and Offered mentioning

confidence: 99%

Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated?

Tanner

Gazzard

Nolan

et al. 2019

Eye

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Angle-closure glaucoma is an aggressive condition that causes millions to become blind worldwide. This review explores the use of prophylactic laser peripheral iridotomy (PI) in patients classified as primary angle-closure suspects (PACS), and additionally, the use of clear lens exchange as a primary treatment option in established angle-closure disease with or without glaucoma. As PI has a strong prophylactic effect in fellow eyes of patients who have had an acute attack, its use has been widely adopted in those patient classified as PACS, but with limited evidence to support this. A large randomised trial conducted in China has demonstrated that although PI reduces the risk of incident angle-closure disease, the incidence of disease which would threaten vision was much lower than anticipated. This suggests that the benefit of prophylactic PI is very limited. Health services data show an association between rising cataract surgical rate and of decreasing rates of acute angleclosure. Age-related growth of the lens is a major component of angle-closure disease. Several studies have shown that clear lens extraction (CLE) effectively lowers IOP in angleclosure. The use of CLE as a primary treatment option has been been tested against LPI in the EAGLE study, a large RCT which enrolled people with angle-closure and an IOP > 30mmHg and those with angle-closure glaucoma. The trial showed CLE to be superior to PI both for IOP control and patient reported quality of life. On these grounds, CLE should be considered for first line treatment of more advanced angle-closure disease.

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Section: Laser Iridotomy Should Continue To Be Discussed and Offered mentioning

confidence: 99%

Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated?

Tanner

Gazzard

Nolan

et al. 2019

Eye

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“…In a case series of 72 patients presenting with AACC to a hospital in Hong Kong, 6 of these patients had taken “antitussive” agents which may have contained anticholinergic components [3]. A case of unilateral AACC was reported in a middle-aged man triggered by a cold preparation containing dextromethorphan (an opiate), promethazine (an antihistamine with anticholinergic side effects), and phenylpropanolamine (a sympathomimetic) [9]. Four cases of simultaneous bilateral AACC precipitated by cold and flu medications are reported in the medical literature.…”

Section: Introductionmentioning

confidence: 99%

Single Dose of Pseudoephedrine Induces Simultaneous Bilateral Acute Angle Closure Crisis

Spencer

Baskin

Giarola

et al. 2019

Case Rep Ophthalmol

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Simultaneous bilateral acute angle closure crisis (AACC) is a sight-threatening ocular emergency. Many “cold and flu” preparations contain compounds with sympathomimetic or anticholinergic qualities that confer a risk of inducing AACC. We present a review of cold and flu preparation-induced AACC, and present a case of simultaneous bilateral AACC triggered by a single oral dose of pseudoephedrine. The challenges facing the clinician in recognizing simultaneous bilateral AACC in the context of an upper respiratory tract infection are addressed. An awareness of this uncommon clinical entity, its pertinent clinical features, risk factors, and the drug classes that may precipitate an attack is critical for the timely diagnosis and management of this ocular emergency. Notably, clinicians must be aware that even a single dose of an implicated medication may trigger an attack of AACC.

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“…Bilateral acute angle closure has been reported after use of topiramate, [ 1 ] hydrochlorothiazide, [ 2 ] selective serotonin reuptake inhibitors, [ 3 , 4 ] sildenafil citrate, [ 5 ] anticough mixtures, [ 6 ] antihistamine, decongestants, [ 7 ] and atropa belladonna, [ 8 ] a herbal ingredient containing the sympathomimetic agent pseudoephedrine. Here we report a case of acute angle closure and myopic shift in both eyes after use of Ma-huang for weight loss.…”

Section: Introductionmentioning

confidence: 99%

Bilateral acute myopia and angle closure glaucoma induced by Ma-huang (Ephedra)

et al. 2017

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Rationale:Cases of bilateral acute angle closure have been reported after use of various drugs.Patient concerns:A 52-year-old woman visited the emergency room and complained of acute bilateral ocular pain and decreased vision accompanied by headache, nausea, and vomiting. One day before, she had started a herbal medicine containing Ma-huang for weight loss. On examinations, myopic shift, edematous cornea, increased intraocular pressure, shallow anterior chamber, and thickened choroid on both eyes were observed.Diagnoses:Angle closure glaucoma induced by drug (Ma-huang).Interventions:To promptly quit the offending drug and apply ocular hypotensives and cycloplegics.Outcomes:Her symptoms and signs were relieved after antiglaucoma medications and no significant recurrence has been occurred.Lessons:Physicians prescribing weight loss medications containing Ma-huang must be aware of the potentially sight-threatening adverse effect of bilateral acute angle closure.

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Angle closure risk from proprietary medicines

Cited by 12 publications

References 1 publication

Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated?

Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated?

Single Dose of Pseudoephedrine Induces Simultaneous Bilateral Acute Angle Closure Crisis

Bilateral acute myopia and angle closure glaucoma induced by Ma-huang (Ephedra)

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