Psychopharmacological Treatment, Intraocular Pressure and the Risk of Glaucoma: A Review of Literature

Abstract

Through the years, the available psychopharmacological treatments have expanded with numerous new drugs. Besides weight gain, gastro-intestinal problems or Parkinson-like symptoms, ocular adverse effects of psychiatric drugs have been reported. These adverse effects are not common, but can be dangerous for the patient. This review summarises the current knowledge on the risk of raised intraocular pressure and glaucoma entailed by psychopharmacological treatment. Also, it provides updated data for clinicians involved in the treatment of patients with glaucoma or glaucoma risk factors. For this purpose, we performed an extensive literature search in the PubMed database using specific terms. Selective serotonin and noradrenaline reuptake inhibitors are the best evidenced as having no association with glaucoma. Antipsychotics, and especially first generation, seem to have no correlation with an increased intraocular pressure and therefore possibly with a risk of glaucoma, although a special attention should be paid when using ziprasidone. Tricyclic antidepressants, benzodiazepines and topiramate should be avoided in patients diagnosed with glaucoma or at risk. Clinicians should be aware of the possible psychotropic drug induced glaucoma and monitor at risk patients closely in order to prevent this condition. Irrespective of the psychopharmacological regimen taken into consideration, the glaucoma patient should be under the strict supervision of the ophthalmologist.

A Review of Ocular Complications Associated with Medications Used for Anxiety, Depression, and Stress

“… 22 , 44 Rare complications may include raised intra-ocular pressure and possible angle closure glaucoma, and patients with narrow angles or currently being managed for glaucoma may require more frequent monitoring. 54 , 55 , 66 , 67 , 71 , 80 Extremely rarely oculomotor complications such as oculogyric crises have been reported with paralysis typically in up-gaze. 60 , 61 …”

“… 70 Given the risk of using medications with such potent anticholinergic properties, selecting newer classes of antidepressants (SSRI and SNRI) can provide crucial alternatives, or even in the case of tricyclic antidepressants the use of those with less anticholinergic effects such as desipramine and nortriptyline can present a lesser risk. 71 For review see Ciobanu et al 71 and Wu et al 57 …”

“…Another frequently used benzodiazepine, alprazolam, has been linked to a higher risk of bilateral acute angle closure glaucoma occurrence due to the influence that benzodiazepine has on the sphincter pupillae and the subsequent narrowing of the iridocorneal angle. 71 A case report has described diplopia in a patient with depression and obsessive-compulsive disorder using lorazepam. 72 Furthermore, one recent case report was of a twenty-one-year-old woman with underlying anxiety disorder who presented with a one-week history of light-headedness and blurred vision due to dilated pupils that were not responsive to light or accommodation that was reversed on cessation of alprazolam.…”

Acute Angle-closure Glaucoma Associated with Aripiprazole: A Case Report

“…1 Although the existing cognitive behavioral model of therapy used to treat addiction addresses negative emotional states through cognitive restructuring and anger management, working on the root causes of the anger can bring deeper healing and improve the overall functioning. 2 In such cases, positive psychology constructs like "forgiveness" can be used to let go of grudges against the transgressor and other negative emotions. In forgiveness therapy (FT), when used in substance use, patients are encouraged to address the core emotional pain and use forgiveness as an emotion-focused coping strategy.…”

The Impact of Antipsychotic Treatment on Neurological Soft Signs in Patients with Predominantly Negative Symptoms of Schizophrenia

“…The centrepiece in the treatment of schizophrenia is antipsychotic medication [ 47 ]. Positive symptoms are effectively managed by dopamine D 2 receptor antagonists or partial agonists [ 37 ]; nonetheless, negative symptoms generally do not respond to these antipsychotics, and their therapy may necessitate alternate techniques for their management [ 41 ].…”