Glaucoma is an eye condition that causes damage to the optic nerve, often due to increased intraocular pressure (IOP) or pressure within the eye. While many people develop glaucoma naturally, certain medications can also increase the risk of glaucoma or worsen an existing condition, especially in those already predisposed to the disease.
What are the different types of drug-induced glaucoma?
Glaucoma can cause blurred vision, halos, and eye pain. Eventually, it can lead to vision loss and blindness. Although there are many forms of glaucoma, four primary types are recognized: open angle-closure glaucoma, normal tension glaucoma, congenital glaucoma, and closed-angle glaucoma (also called narrow-closure or acute).
The type of glaucoma determines how quickly symptoms occur and how noticeable they are. Some progress slowly, while others, like acute angle-closure glaucoma, rapidly cause vision loss.
Out of all the types of glaucoma, two are commonly associated with medication use.
Open-angle glaucoma
Open-angle glaucoma is the most common form of the disease and is usually less symptomatic in the early stages. Corticosteroids, anti-inflammatory medications, can increase eye pressure and contribute to this condition.
Steroids may be administered in several ways, all of which can increase eye pressure. Typical forms of steroids include eye drops, inhalers, skin creams, and oral tablets.
Angle-closure glaucoma
Angle-closure glaucoma is a more acute form, often accompanied by noticeable symptoms. Certain medications are more likely to trigger or worsen this form. Individuals with narrow drainage angles, the area where fluid drains from the front of the eye, may be particularly susceptible.
Various medications, including antidepressants, allergy and cold medications, and drugs that contain sulfa, can worsen angle-closure glaucoma.
Some medications can help manage glaucoma. If surgery, such as an iridotomy, isn’t a recommended treatment, most glaucoma patients will be prescribed medications. Glaucoma medications can include prescription eye drops or beta-blockers.
However, it can be just as important for high-risk individuals to avoid certain medications to prevent the worsening or onset of the condition.
High-risk medications by category
Some types of medications are more likely to cause side effects that pose a risk for those susceptible to glaucoma.
Psychiatric medications
Psychiatric medications are associated with an increased risk of angle-closure glaucoma. Antidepressants like paroxetine, fluoxetine, and vilazadone may increase eye pressure. Other psychiatric medications known to affect ocular pressure include:
- Selective serotonin reuptake inhibitors (SSRIs): Commonly prescribed for depression and anxiety.
- Tricyclic antidepressants: Used for depression, drugs like imipramine may increase eye pressure.
- Anti-anxiety medications: Certain medications used for anxiety may also trigger glaucoma in susceptible individuals.
Respiratory medications
Medications used to manage respiratory conditions can increase the risk of angle-closure glaucoma. Inhalers, such as Ipratropium for COPD, may pose a risk. Other respiratory drugs that can cause adverse effects for those with glaucoma include:
- Bronchodilators: These medications can affect eye pressure in some individuals.
- Adrenergic agonists: Common in asthma inhalers, these drugs may impact glaucoma.
- Anticholinergic inhalers: Medications like those found in some asthma and COPD inhalers.
Antihistamines
Allergy, cold, and flu medications can pose a risk of glaucoma or worsen the condition in individuals. Antihistamines, often used to treat allergies, can affect the drainage angles in the eye. Common cold and allergy medications, such as diphenhydramine, can trigger angle closure in susceptible individuals. Over-the-counter cold and flu remedies that contain decongestants can also elevate eye pressure.
Blood pressure medications
Certain blood pressure drugs, such as calcium channel blockers and angiotensin II receptor blockers, may increase the risk of glaucoma. Other medications, like ACE inhibitors, may also increase the risk of glaucoma. However, beta-blockers like timolol can lower intraocular pressure, which can help treat glaucoma.
Anti-nausea medications
Often used to relieve motion sickness, these drugs may also increase eye pressure. Drugs like Phenergan and Meclizine have anticholinergic effects that dilate the pupil and block the drainage system of the eye, increasing intraocular pressure.
Incontinence medications
Overactive bladder medications, like Oxybutynin, may inadvertently raise pressure in the eye.
Migraine treatments
Certain treatments can affect the eye’s drainage pathways. For example, topiramate (Topamax), a medication commonly prescribed for migraines, and Sumatriptan can increase the risk of developing acute angle-closure glaucoma.
Sulfa-containing drugs
Drugs like sulfamethoxazole, an antibiotic used for many infections, acetazolamide (Diamox), and trimethoprim-sulfamethoxazole (Bactrim) can cause swelling of the eye structures, leading to angle-closure glaucoma.
Botulinum toxin injections
Botox injections around the eyes, whether cosmetic or medical, can increase eye pressure, especially in people with narrow angles.
What are some risk factors for drug-induced glaucoma?
Some individuals are more prone to drug-induced glaucoma due to underlying risk factors. Those with the following conditions or characteristics may be at higher risk:
- Narrow angles or a shallow anterior chamber: An ocular structure that makes it easier for pressure to build up.
- Family history of glaucoma: A genetic predisposition to the condition.
- Advanced age: Older adults are more susceptible.
- Female gender: Women are more likely to develop narrow-angle glaucoma.
- Asian or Hispanic ethnicity: These populations are at greater risk of angle-closure glaucoma.
If you take any medications that could increase your risk for glaucoma, schedule regular eye exams and be proactive about any vision changes. For those with existing glaucoma or elevated risk factors, one of our ophthalmologists can work with your primary care provider to adjust your medications if necessary.
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Common Medications That Can Cause or Worsen Glaucoma FAQs
What medications can cause eye pressure?
Many medications can increase eye pressure, including antihistamines and decongestants, antidepressants, and gastrointestinal meds. If you have glaucoma or are at risk of developing the condition, be sure to talk to your eye doctor and primary care physician about which medications are best for you.
What medications should be avoided with glaucoma?
Individuals with glaucoma should avoid medications that can increase eye pressure. These medications can include oral steroids, sulfonamides, anticholinergics, and anticoagulants.
Can corticosteroids cause glaucoma?
Corticosteroids can increase intraocular pressure. If the pressure is high enough for long enough, glaucoma can result. One study reported that any form of steroid administration, including topical, can cause glaucoma.
Sources:
Steroid-Induced Glaucoma. https://www.ncbi.nlm.nih.gov/books/NBK430903/#:~:text=Any%20form%20of%20steroid%20administration,corticosteroid%20treatment%20for%20inflammatory%20conditions.
Types of Glaucoma. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/types-glaucoma
A Review of Systemic Medications that May Modulate the Risk of Glaucoma. https://pmc.ncbi.nlm.nih.gov/articles/PMC7002596/ – :~:text=Medication classes covered in this,, postmenopausal hormones, and cannabinoids.
