Drug-induced secondary glaucoma

Several classes of drugs have potential to cause an elevation of IOP which may occur either by an open-angle mechanism or a close-angle mechanism. Drug-induced elevation of IOP is commonly has an open-angle mechanism. The most commonly recognized medications associated with this mechanism are the corticosteroids. Acute angle closure glaucoma is a potentially blinding side effect of local and systemic drugs, including antipsychotic drugs, antidepressants, monoamine oxidase inhibitors, antihistamines, antiparkinsonian agents, antispasmolytic drugs, mydriatic agents, the sympathetic agents and botulinum toxin, especially in individuals with predisposing narrow angles of the anterior chamber. Sulfamate derivative medications may induce angle closure by a different angle closure mechanism, involving anterior rotation of the ciliary body. Clinicians should be mindful of the possible drug-induced glaucoma, whether or not it is listed as a contraindication and, if in doubt, ophthalmological consultation is recommended.