Introduction:

Acute angle-closure glaucoma is a sight-threatening condition characterized by a sudden increase in intraocular pressure due to the blockage of the eye's drainage system. In some cases, certain medications have been associated with triggering this condition. This comprehensive article explores the causes, symptoms, diagnosis, treatment, and prevention of drug-induced acute angle-closure glaucoma.

Causes:

Certain medications can induce acute angle-closure glaucoma by causing the pupil to dilate and narrowing the angle between the iris and cornea. Medications that have been linked to this condition include:

• Anticholinergic Drugs: These medications inhibit the action of acetylcholine, leading to pupil dilation and angle narrowing. Examples include some antidepressants, antihistamines, and medications for overactive bladder.
• Sulfa-based Medications: Some sulfa-containing drugs can cause ciliary body swelling, which can push the iris forward and trigger angle closure.
• Antidepressants: Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may have anticholinergic properties that contribute to angle closure.
• Antipsychotics: Certain antipsychotic medications have been associated with acute angle-closure glaucoma due to their anticholinergic effects.

Symptoms:

Acute angle-closure glaucoma can present with a sudden onset of severe symptoms, including:

• Severe Eye Pain: Often described as a deep ache or throbbing sensation.
• Decreased Vision: Blurred or hazy vision.
• Halos Around Lights: Patients may see rainbow-colored halos around light sources.
• Red Eye: The affected eye may appear red and inflamed.
• Headache: Accompanied by eye pain and nausea in some cases.

Diagnosis:

Diagnosing drug-induced acute angle-closure glaucoma involves a comprehensive eye examination, and a detailed medical history, including current medication use. Additional diagnostic tests may include:

• Tonometry: Measuring intraocular pressure to confirm angle closure.
• Slit-Lamp Biomicroscopy: Evaluating the anterior segment of the eye for signs of angle closure.
• Gonioscopy: Using a special lens to visualize the angle between the iris and cornea.
• Optical Coherence Tomography (OCT): Imaging the retina and optic nerve to assess for any damage.
• Visual Field Testing: To detect any loss of peripheral vision.

Treatment:

The immediate treatment goal for drug-induced acute angle-closure glaucoma is to reduce intraocular pressure promptly. Treatment options may include:

• Topical Medications: Eye drops to lower intraocular pressure, such as beta-blockers, prostaglandin analogs, and alpha-adrenergic agonists.
• Oral Medications: Systemic medications, like carbonic anhydrase inhibitors and osmotic agents, may be prescribed.
• Laser Peripheral Iridotomy (LPI): A laser procedure to create a small hole in the iris, allowing aqueous humor to flow freely and relieve angle closure.
• Acetazolamide: A carbonic anhydrase inhibitor that can rapidly lower intraocular pressure.
• Surgery: In severe cases, if medical treatment is insufficient, surgical intervention may be necessary.

Prevention:

Preventing drug-induced acute angle-closure glaucoma involves vigilant medication management and awareness of the patient's medical history and risk factors. Healthcare providers should consider patients' ocular health when prescribing medications with known potential side effects on intraocular pressure.

Conclusion:

Drug-induced acute angle-closure glaucoma can have severe consequences for vision if not promptly diagnosed and managed. Healthcare professionals and patients must be aware of medications that may increase the risk of angle closure and take preventive measures to preserve ocular health.

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