From the FDA Drug Label
As with all drugs which exert an anticholinergic effect, and/or cause mydriasis, chlorpromazine should be used with caution in patients with glaucoma. The antipsychotic medication chlorpromazine may exacerbate glaucoma due to its anticholinergic effect and/or mydriasis, but it does not directly cause glaucoma.
- Key points:
- Use with caution in patients with glaucoma
- Anticholinergic effect and/or mydriasis may worsen glaucoma
- No direct evidence of causing glaucoma 1
From the Research
Antipsychotic medications can potentially increase the risk of glaucoma, particularly angle-closure glaucoma, but the risk is generally low and mostly associated with specific types of antipsychotics and pre-existing narrow anterior chamber angles. The risk of glaucoma with antipsychotic use is a concern due to the potential for these medications to cause pupillary dilation and relaxation of the iris, which may precipitate angle closure in predisposed individuals 2. Key factors to consider include:
- The type of antipsychotic used, with first-generation (typical) antipsychotics like chlorpromazine and second-generation (atypical) antipsychotics with strong anticholinergic properties posing a higher risk 3, 4.
- The presence of pre-existing narrow-angle glaucoma, which requires cautious use of these medications and close ophthalmological monitoring 2, 4.
- The importance of regular eye examinations for patients requiring antipsychotic treatment who have glaucoma or risk factors, to minimize the risk of vision loss 5. It is essential to weigh the benefits of antipsychotic treatment against the potential risks and to choose agents with lower anticholinergic properties when possible, especially in patients with pre-existing glaucoma or risk factors 2, 4. Symptoms of acute angle-closure glaucoma, such as eye pain, redness, blurred vision, seeing halos around lights, nausea, and vomiting, require immediate medical attention 3, 5. The most recent and highest quality study 4 suggests that while antipsychotics may pose a risk, the overall risk is low, and careful patient selection and monitoring can minimize this risk.