Minoxidil Use in Glaucoma Patients
Both topical and oral minoxidil can be safely used by patients with glaucoma, as minoxidil does not affect intraocular pressure or worsen glaucoma.
Topical Minoxidil Safety
Topical minoxidil has no contraindications in glaucoma patients and does not impact intraocular pressure, making it safe for both open-angle and narrow-angle glaucoma 1.
The primary concerns with topical minoxidil are dermatologic (scalp irritation, contact dermatitis) rather than ophthalmologic 2, 3.
While one case report suggested a possible association between topical 5% minoxidil and non-arteritic anterior ischemic optic neuropathy, this resolved after discontinuation and represents an extremely rare occurrence 4. This should not preclude use in glaucoma patients, as the mechanism is unrelated to intraocular pressure or glaucoma progression.
Oral Minoxidil Safety
Low-dose oral minoxidil (LDOM) is also safe for glaucoma patients, as it does not affect intraocular pressure 1.
In a large multicenter study of 1,404 patients taking LDOM, systemic adverse effects were infrequent (lightheadedness 1.7%, fluid retention 1.3%, tachycardia 0.9%), with only 1.7% discontinuing treatment due to side effects 5. Notably, no ophthalmologic complications or glaucoma-related issues were reported.
The cardiovascular effects of LDOM (used at doses below those that lower blood pressure) are minimal and unrelated to glaucoma management 2, 5.
Important Clinical Considerations
Patients should avoid scalp occlusion (tight caps, wigs immediately after application) when using topical minoxidil, as this increases systemic absorption and risk of hypertrichosis 6.
Hypertrichosis (unwanted hair growth) is the most common adverse effect of both formulations, occurring in approximately 15% of patients on oral minoxidil, though it rarely leads to discontinuation 5.
No special monitoring of intraocular pressure is required specifically for minoxidil use, though glaucoma patients should continue their routine ophthalmologic follow-up as recommended for their condition 7.
Contrast with Medications That Require Caution
Unlike certain medications that do require caution in glaucoma (such as anticholinergics in narrow-angle glaucoma, or corticosteroids which can elevate intraocular pressure), minoxidil poses no such risk 8. This makes it a straightforward choice for hair loss treatment in glaucoma patients without need for additional ophthalmologic consultation or monitoring beyond standard glaucoma care.