Afrin Can Worsen Glaucoma and Should Be Avoided in Glaucoma Patients
Afrin (oxymetazoline) nasal spray can cause hypertension and glaucoma complications, and the American Academy of Otolaryngology-Head and Neck Surgery explicitly warns that these medications may cause glaucoma as a potential adverse effect. 1
Primary Concern: Increased Intraocular Pressure Risk
While one small research study from 2006 paradoxically showed oxymetazoline lowered IOP in 30 glaucoma patients after 5 days of use 2, this finding contradicts:
- The official guideline warning from the American Academy of Otolaryngology-Head and Neck Surgery that oxymetazoline can cause glaucoma 1
- The mechanism of action as an alpha-adrenergic agonist, which typically raises IOP through vasoconstriction
- Clinical practice patterns where vasoconstrictors are generally avoided in glaucoma patients
The single positive study 2 should not override the guideline-level caution, especially given the serious consequences of IOP elevation in glaucoma patients.
Additional Serious Vascular Risk
A case report documented branch retinal artery occlusion in a patient after excessive Afrin use, attributed to sympathomimetic drug-induced platelet fibrin embolus formation 3. This represents a vision-threatening complication beyond IOP concerns.
Clinical Recommendations
Avoid oxymetazoline nasal spray in patients with glaucoma due to:
- Guideline-level warnings about glaucoma complications 1
- Risk of hypertension that could affect ocular perfusion 1
- Documented retinal vascular occlusion risk 3
- Conflicting evidence that doesn't justify the risk in a vulnerable population
Common Pitfall to Avoid
Do not assume that over-the-counter nasal decongestants are safe in glaucoma patients. The systemic absorption of oxymetazoline can produce cardiovascular and ocular effects that may worsen glaucoma control or cause acute complications 1, 3.