Augmentin is Safe in Angle-Closure Glaucoma
Augmentin (amoxicillin-clavulanic acid) can be safely prescribed to patients with chronic or a history of acute angle-closure glaucoma without dose adjustment, as it lacks anticholinergic or sympathomimetic properties that precipitate angle closure.
Mechanism of Drug-Induced Angle Closure
The medications that trigger acute angle-closure glaucoma work through specific mechanisms that do not apply to Augmentin:
- Anticholinergic agents cause mid-pupillary dilation that bunches peripheral iris tissue into anatomically narrow angles, obstructing aqueous outflow 1, 2
- Sympathomimetic agents (adrenergic agonists) can precipitate angle closure through pupillary dilation in predisposed individuals 3, 4
- Sulfa-based medications (like topiramate) induce ciliary body edema causing forward displacement of the lens-iris diaphragm through a completely different mechanism 1, 5
Why Augmentin Does Not Pose Risk
Augmentin is a beta-lactam antibiotic combination that:
- Has no anticholinergic activity that would cause pupillary dilation 3, 4
- Contains no sympathomimetic components that could trigger mydriasis 6, 7
- Is not a sulfonamide derivative that would cause ciliary body edema 5
High-Risk Medications to Actually Avoid
The medications that genuinely require caution in angle-closure glaucoma include:
- Anticholinergics: antihistamines (brompheniramine), antidepressants, antiparkinsonian agents, antispasmolytic drugs 2, 6, 7
- Sympathomimetics: phenylephrine, ephedrine, salbutamol 5
- Sulfa-based drugs: topiramate, acetazolamide, hydrochlorothiazide 5
- Amantadine specifically should not be used in untreated angle-closure glaucoma due to anticholinergic effects causing mydriasis 8
Clinical Pitfall to Avoid
The common error is assuming all medications require restriction in glaucoma patients. Only drugs with anticholinergic, sympathomimetic, or sulfonamide properties pose risk 3, 4. Unnecessarily withholding antibiotics like Augmentin can lead to untreated infections with significant morbidity, while providing no ophthalmologic benefit.
When Ophthalmologic Consultation Is Actually Needed
Consultation should precede use of: