Medications Associated With Narrow Angle Glaucoma

Aka: Medications Associated With Narrow Angle Glaucoma, Drug-Induced Increased Introcular Pressure, Medication-Induced Intraocular Pressure, Medication Causes of Narrow Angle Glaucoma

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II. Background

  1. Medications that dilate the pupil (Mydriasis ) decrease the anterior chamber angle
  2. Narrowed anterior chamber angle may increase Intraocular Pressure, triggering Narrow Angle Glaucoma
  3. Systemic agents may also cause ciliary body edema

III. Causes: Eye Preparations

  1. Eye Dilating Drops (Mydriatics)
  2. Ophthalmic Anticholinergic Agents

IV. Causes: Autonomic Medications

  1. Adrenergic Medications (including Drugs of Abuse)
    1. Nephazoline Intranasal spray
    2. Inhaled Salbutamol
    3. Cocaine
    4. Methamphetamine
  2. Anticholinergic Medications
    1. Oxybutynin
    2. Scopolamine
    3. Benztropine (Cogentin)
    4. Trihexyphenidyl
  3. Antihistamines
    1. Diphenhydramine (Benadryl)
    2. Cimetidine (Tagamet)

V. Causes: Neuropsychiatric Medications

  1. Antidepressant Medications
    1. Bupropion
    2. Escitalopram (Lexapro)
    3. Fluoxetine (Prozac)
    4. Tricylic Antidepressants (e.g. Amitriptyline)
    5. Venlafaxine (Effexor)
  2. Antipsychotic Medications
    1. Olanzapine (Zyprexa)
    2. Quetiapine
    3. Thioridazine

VI. Causes: Sulfa-based Medications

  1. Topiramate
  2. Trimethoprim-Sulfamethoxazole

VII. Causes: Miscellaneous Medications

  1. Corticosteroids
    1. Risk of Open Angle Glaucoma with longterm Systemic Corticosteroids and especially intra- and periocular Corticosteroids
  2. Mefenamic Acid (Ponstel)
  3. Onabotulinum Toxin A
  4. Promethazine (Phenergan)

VIII. References

  1. Harris (2023) Am Fam Physician 107(3): 238-46 [PubMed]

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