Glaucoma

Abstract

In their Seminar, Jost B Jonas and colleagues (Nov 11, 2017, p 2183)1Jonas JB Aung T Bourne RR Bron AM Ritch R Panda-Jonas S Glaucoma.Lancet. 2017; 390: 2183-2193Summary Full Text Full Text PDF PubMed Scopus (621) Google Scholar do not include drugs as a possible trigger of glaucoma. Drug-induced glaucoma is potentially blinding but preventable.2Razeghinejad MR Myers JS Katz LJ Iatrogenic glaucoma secondary to medications.Am J Med. 2011; 124: 20-25Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar Several classes of drugs, such as adrenergic agonists, cholinergics, anticholinergics, sulfa-based drugs, antidepressants, antipsychotics, anti-Parkinson's drugs, anticoagulants, and histamine H1 and H2 receptor antagonists, have been reported to induce or precipitate acute angle-closure glaucoma.3Tripathi RC Tripathi BJ Haggerty C Drug-induced glaucomas: mechanism and management.Drug Saf. 2003; 26: 749-767Crossref PubMed Scopus (108) Google Scholar, 4Razeghinejad MR Pro MJ Katz LJ Non-steroidal drug-induced glaucoma.Eye (Lond). 2011; 25: 971-980Crossref PubMed Scopus (34) Google Scholar At least a third of cases of acute angle-closure glaucoma are associated with an over-the-counter or prescription drug.5Lachkar Y Bouassida W Drug-induced acute angle closure glaucoma.Curr Opin Ophthalmol. 2007; 18: 129-133Crossref PubMed Scopus (163) Google Scholar Patients with a narrow iridocorneal angle are at high risk. Drugs that have sympathomimetic or parasympatholytic properties are the most common for inducing pupillary block angle-closure glaucoma.4Razeghinejad MR Pro MJ Katz LJ Non-steroidal drug-induced glaucoma.Eye (Lond). 2011; 25: 971-980Crossref PubMed Scopus (34) Google Scholar Sulfa-based drugs such as topiramate, acetazolamide, chlortalidone, co-trimoxazole, sumatriptan, and hydrochlorothiazide have been reported to produce non-pupillary block angle-closure glaucoma.2Razeghinejad MR Myers JS Katz LJ Iatrogenic glaucoma secondary to medications.Am J Med. 2011; 124: 20-25Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar These drugs induce an idiosyncratic lens swelling, shallowing of the anterior chamber, increased intraocular pressure, choroidal expansion, and retinal oedema resulting in acute angle-closure glaucoma and transient myopia. To manage increased intraocular pressure, sulfa-based drugs should be discontinued and intraocular pressure should be controlled by antihypertensive medicines.3Tripathi RC Tripathi BJ Haggerty C Drug-induced glaucomas: mechanism and management.Drug Saf. 2003; 26: 749-767Crossref PubMed Scopus (108) Google Scholar, 4Razeghinejad MR Pro MJ Katz LJ Non-steroidal drug-induced glaucoma.Eye (Lond). 2011; 25: 971-980Crossref PubMed Scopus (34) Google Scholar Topical steroid, cycloplegic drugs, and aqueous suppressants could also be effective in treating this condition. However, topical miotics are contraindicated in this condition. Drugs that cause or exacerbate open-angle glaucoma are mostly glucocorticoids, docetaxel, paclitaxel, and imatinib.2Razeghinejad MR Myers JS Katz LJ Iatrogenic glaucoma secondary to medications.Am J Med. 2011; 124: 20-25Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 3Tripathi RC Tripathi BJ Haggerty C Drug-induced glaucomas: mechanism and management.Drug Saf. 2003; 26: 749-767Crossref PubMed Scopus (108) Google Scholar Glucocorticoids given systemically, topically, or intravitreally can lead to the development of open-angle glaucoma. Patients with primary open-angle glaucoma; elderly or young patients; and patients with type 1 diabetes, high myopia, and angle-recession glaucoma are at greater risk of glucocorticoid induced glaucoma than other patients.2Razeghinejad MR Myers JS Katz LJ Iatrogenic glaucoma secondary to medications.Am J Med. 2011; 124: 20-25Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar We declare no competing interests. GlaucomaGlaucoma is a heterogeneous group of diseases characterised by cupping of the optic nerve head and visual-field damage. It is the most frequent cause of irreversible blindness worldwide. Progression usually stops if the intraocular pressure is lowered by 30–50% from baseline. Its worldwide age-standardised prevalence in the population aged 40 years or older is about 3·5%. Chronic forms of glaucoma are painless and symptomatic visual-field defects occur late. Early detection by ophthalmological examination is mandatory. Full-Text PDF Glaucoma – Authors' replyWe thank Chaker Ben Salem and colleagues for their Correspondence and agree with them that the role of drugs, particularly steroids, in the development of glaucoma should have been pointed out more clearly in our Seminar.1 Steroids, more if applied topically on the cornea than if given orally, nasally, cutaneously, or by inhalation, can increase the intraocular pressure, with the pressure rising as high as 50 or 60 mm Hg for some patients.2–4 Usually this rise in pressure takes 1–3 months to develop. Full-Text PDF