Short-Term Tests of Anticholinergic Medication in Open-Angle Glaucoma

Mydriasis and glaucoma: exploding the myth. A systematic review

“…Several studies have shown that IOP may rise transiently following mydriasis in some eyes with chronic glaucoma by mechanisms not involving angle closure[28,29,30,31,32,33,34,35,36,37,38,39,40,41]. To put into context the degree of IOP rise represented in such studies, normal IOP is accepted as 11–21 mmHg (population mean 16 mmHg ± 2 sd ), and about 30% of normal eyes show a diurnal fluctuation of IOP of up to 5 mmHg.…”

“…Secondly, there is great variation in the IOP response both between and within the studies. For example, following mydriasis with cyclopentolate, Lazenby and colleagues[29] found a transient IOP rise in 14/28 of eyes (50%) compared to 9/40 (23%) in the study by Harris[28]. In the study by Shaw and Lewis[30] of 116 eyes, IOP rose ≥5 mmHg in 37 eyes (32%), actually fell in 34 eyes (29%), and remained unchanged or rose < 5 mmHg in 45 eyes (38%) after mydriasis with the combination of tropicamide and phenylephrine.…”

Intraocular pressure in schizophrenic patients treated with psychiatric medications

“…On the other hand, two atypical antipsychotics, sulpiride and clozapine, were found to have hypotensive intraocular pressure activity (17) . In spite of the potential effects of these psychiatric drugs for either raising IOP or exacerbating acute closed-angle glaucoma, studies have not been demonstrating high rates of both IOP increase and glaucoma in patients using those drugs (16,(18)(19)(20)(21)(22)(23) . However, an ophthalmic evaluation is recommended before the tricyclic antidepressant drug therapy, which are the main agents involved in this side effect, and in patients with narrow anterior chamber angle these drugs must be avoided (3,15) .…”