What type of glaucoma do you have?

 

Glaucoma Types and Medications to Avoid

A guide for patients on the two main forms of glaucoma and which medicines to watch

Sandra Lora Cremers, MD, FACS
Visionary Eye Doctors
11300 Rockville Pike, Suite 1202
Rockville, MD 20852 • 301 896 0890

Glaucoma is a condition where pressure builds up inside the eye and slowly damages the optic nerve, the cable that carries images to the brain. If it is not treated, it can cause permanent vision loss. There are two main types, and they behave very differently. The most important point about medicines: pupil dilating and anticholinergic drugs are mainly a concern for narrow angle glaucoma, not open angle glaucoma. Steroids can raise eye pressure in either type.

Figure. Key ocular structures in glaucoma, and how fluid drains in each type

A. Healthy eye. Fluid drains out where the iris meets the cornea (the angle).

B. Open angle (slow filter) and C. Angle closure (iris blocks the drain).

Open Angle Glaucoma (most common)

The drain is open but works poorly, like a slow sink. It develops quietly over years with no symptoms until vision is already lost, which is why it is called the sneak thief of sight.

Narrow Angle (Angle Closure) Glaucoma

The drain is physically blocked by the iris, like a stopper over a plughole. An acute attack brings severe eye pain, headache, nausea, blurred vision, and halos around lights. Go to the emergency room right away.

Medicines and Open Angle Glaucoma

Most medicines are safe. The one important exception is steroids (corticosteroids) in any form, including pills such as prednisone, inhalers, nasal sprays, skin creams, and eye drops. These can raise eye pressure. If you need steroids, your eye doctor should check your pressure regularly.

Medicines to Avoid or Use With Caution in Narrow Angle Glaucoma

Many common medicines can trigger a dangerous attack by widening the pupil or swelling structures inside the eye. Check with your eye doctor before starting any of these.

Allergy and cold medicines. Diphenhydramine (Benadryl), chlorpheniramine, pseudoephedrine (Sudafed), and many cold or flu combination products.

Bladder medicines. Oxybutynin (Ditropan), solifenacin (Vesicare), tolterodine (Detrol).

Antidepressants. Amitriptyline (Elavil), nortriptyline (Pamelor), paroxetine (Paxil), fluoxetine (Prozac), bupropion (Wellbutrin).

Anxiety medicines. Alprazolam (Xanax), diazepam (Valium).

Antipsychotic medicines. Olanzapine (Zyprexa), quetiapine (Seroquel).

Stomach medicines. Cimetidine (Tagamet), dimenhydrinate (Dramamine), metoclopramide (Reglan).

Seizure and migraine medicines. Topiramate (Topamax), which can cause an attack even in people without narrow angles, and sumatriptan (Imitrex).

Parkinson medicines. Benztropine (Cogentin), trihexyphenidyl (Artane).

Eye dilating drops. Tropicamide, phenylephrine, and other drops used to widen the pupil.

Other. Botulinum toxin (Botox), nasal decongestant sprays (naphazoline), and the recreational drugs cocaine and methamphetamine.

Important Notes for All Glaucoma Patients

1Tell every doctor, pharmacist, and dentist that you have glaucoma, and say which type you have.

2If you have narrow angle glaucoma and have already had a laser iridotomy, many of the medicines above may become safe. Ask your eye doctor first.

3Steroids in any form can raise eye pressure in either type. Always tell your eye doctor if you are prescribed a steroid.

Open angle at a glance

Avoid steroids or use them only with pressure checks. Most other medicines are fine. Keep every appointment, since there are no warning symptoms.

Narrow angle at a glance

Avoid pupil widening and anticholinergic drugs unless cleared by your eye doctor. A laser iridotomy may make many of them safe.

Seek emergency care right away if you have sudden eye pain, headache, nausea, blurred vision, or see halos around lights.

This handout is general education and does not replace advice from your own eye doctor. Bring your full medicine list to every visit.
Sandra Lora Cremers, MD, FACS • Visionary Eye Doctors • 11300 Rockville Pike, Suite 1202, Rockville, MD 20852 • 301 896 0890