Seroquel (Quetiapine) and Eye Condition Contraindications
Seroquel is not absolutely contraindicated in any specific eye condition, but it should be used with extreme caution in patients at risk for angle-closure glaucoma, and regular ophthalmologic monitoring is mandatory due to cataract risk. 1
Cataracts: Mandatory Monitoring Required
The FDA label explicitly requires lens examination at treatment initiation and every 6 months during chronic treatment because cataract development was observed in chronic animal studies, and lens changes have been documented in adults, children, and adolescents during long-term quetiapine treatment 1
Slit lamp examination or other appropriately sensitive methods adequate to detect cataract formation must be performed at baseline or shortly after initiation, then at 6-month intervals throughout treatment 1
While a causal relationship between quetiapine and cataracts has not been definitively established in humans, the possibility of lenticular changes cannot be excluded 1
Angle-Closure Glaucoma: Use with Extreme Caution
Second-generation antipsychotics like quetiapine may have a greater impact on intraocular pressure than first-generation antipsychotics, and should be used with caution in predisposed patients 2
Patients with narrow anterior chamber angles are at risk for drug-induced angle-closure glaucoma from antipsychotic medications 3
If angle-closure glaucoma develops, bilateral involvement and even blindness can occur 3
Predisposed patients exposed to psychotropic drugs should be followed by an ophthalmologist 2
Open-Angle Glaucoma: Generally Safe
Quetiapine is not contraindicated in open-angle glaucoma 4, 5
Psychotropic medications, including antipsychotics, do not typically increase intraocular pressure in patients with treated or untreated open-angle glaucoma 4, 5
Critical Clinical Pitfalls
The product package insert may mention "glaucoma" as a contraindication without specifying the type - this typically refers to angle-closure glaucoma risk, not open-angle glaucoma 3
Clinicians must distinguish between angle-closure and open-angle glaucoma when assessing contraindications, as the risks differ substantially 3
When in doubt about a patient's glaucoma type or angle anatomy, consult an ophthalmologist before initiating quetiapine 3, 2