What agents can precipitate glaucoma?

From the Guidelines

Agents that can precipitate glaucoma include sulfonamides, topiramate, and drugs with adrenergic or anticholinergic effects, such as ipratropium bromide, salbutamol-containing inhalers, and phenothiazines. These medications can cause ciliary body edema or induce angle narrowing, potentially leading to an angle-closure attack 1.

Key Medication Classes to Avoid

• Sulfonamides: can cause ciliary body edema, increasing the risk of angle closure 1
• Topiramate: can cause ciliary body edema, leading to secondary angle closure 1
• Adrenergic medications: can induce angle narrowing, potentially precipitating an angle-closure attack 1
• Anticholinergic medications: can trigger acute angle-closure glaucoma in susceptible individuals by causing pupillary dilation that blocks drainage channels 1

Patient Evaluation

When evaluating patients, it is essential to ask about symptoms that may suggest previous episodes of intermittent angle closure, such as blurred vision, halos around lights, eye pain, headache, eye redness, and symptoms following stress or dilated eye examination 1. A thorough review of the patient's family history and medication use is also crucial to identify potential risk factors for glaucoma.

Clinical Implications

In patients with narrow anterior chamber angles or other predisposing factors, these agents should be used cautiously or avoided altogether, and regular eye pressure monitoring may be necessary when these medications cannot be avoided. By being aware of the potential risks associated with these medications, clinicians can take steps to minimize the risk of precipitating glaucoma in susceptible individuals.

From the FDA Drug Label

5.3 Acute Glaucoma Atropine may precipitate acute glaucoma. Ophthalmic Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi or viruses. Ophthalmic blurred vision, cataracts (including posterior subcapsular cataracts), central serous chorioretinopathy, establishment of secondary bacterial, fungal and viral infections, exophthalmos, glaucoma, increased intraocular pressure

Agents that can precipitate glaucoma include:

• Atropine 2
• Corticosteroids, such as prednisone 3 and 3

From the Research

Agents that can Precipitate Glaucoma

• Corticosteroids (glucocorticoids) can increase the risk of glaucoma by raising the intraocular pressure (IOP) when administered exogenously or in certain conditions of increased endogenous production 4
• Anticholinergic drugs can be prescribed to patients diagnosed with closed-angle glaucoma, which may increase the intraocular pressure 5
• Glucocorticoids are a class of anti-inflammatory drugs that can increase intraocular pressure resulting in steroid-induced glaucoma 6
• Various classes of medications can trigger acute angle closure in patients with predisposing factors, including:
  • Adrenergic agonists
  • Anticholinergics
  • Cholinergics
  • Sulfonamides
  • Supplements
  • Serotonergic medications 7
• Five major classes of glaucoma medications are presently available for clinical use, including:
  • Alpha-adrenergic agonists
  • Beta-adrenergic antagonists (beta-blockers)
  • Carbonic anhydrase inhibitors (CAIs)
  • Cholinergics
  • Prostaglandin analogs (PGAs) 8