Drug-induced acute angle closure glaucoma

Abstract

Most attacks of acute angle closure glaucoma involving pupillary block occur in individuals that are unaware that they have narrow iridocorneal angles. Practitioners using any of the above drugs should be aware of their potential to cause acute angle closure.

Acute angle closure glaucoma following ileostomy surgery

“…Angle-closure glaucoma has been previously reported in patients undergoing general anesthesia for non-ophthalmologic surgery (8,12,(17)(18)(19) . Many factors may contribute to the onset of an acute angle closure attack during anesthesia in predisposed individuals: CO 2 retention (20,21) ; endotracheal intubation associated with laryngospasm and cough leading to IOP augmentation, and the use of anticholinergic and adrenergic drugs.…”

“…Many factors may contribute to the onset of an acute angle closure attack during anesthesia in predisposed individuals: CO 2 retention (20,21) ; endotracheal intubation associated with laryngospasm and cough leading to IOP augmentation, and the use of anticholinergic and adrenergic drugs. Moreover, the preoperative period carries the risk of psychological stress and darkness-induced mydriasis that may increase the risk of glaucoma attacks (17) .…”

Response to Dr Wishart (Non-steroidal drug-induced glaucoma)

“…A further in vitro model tested the toxicity of 0.15% TB (higher than used here) in RPE cells and reported its safety. 4 Subsequent in vivo experiments with subretinal 0.15% TB injections in rabbits showed significant photoreceptor and RPE damage. 2 Even the injection of an iso-osmolar balanced salt solution has been shown to cause mild photoreceptor outer-segment damage.…”

“…Most cases of pharmacologically induced angle closure have reportedly been due to a pupillary block mechanism, with fewer cases being secondary to plateau iris configuration and choroidal effusions. 3,4 Therefore, a prophylactic laser peripheral iridotomy would be expected to be protective. The decision as to whether that would be appropriate given the risks of angleclosure glaucoma is weighed against the risks of the laser procedure.…”

Current Diagnosis and Management of Angle-Closure Glaucoma

“…Other systemic medications like antiparkinsonian drugs, tricyclic antidepressants, monoamine oxidase inhibitors, vasoconstrictors and anticholinergics in general may produce an acute angle-closure glaucoma attack in predisposed patients. (Lachkar & Bouassida, 2007). The use of two or more drugs, potentiates the mydriatic effect and the risk of an acute attack in predisposed eyes.…”