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Decrease of ocular pressure with oral metyrapone. A double-masked crossover trial.

L Levi, B Schwartz

    Archives of Ophthalmology (Chicago, Ill. : 1960)
    |June 1, 1987
    PubMed
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    Lowering plasma cortisol levels with metyrapone tartrate significantly reduced intraocular pressure in subjects with elevated ocular pressure. This suggests glucocorticoids play a role in regulating eye pressure.

    Area of Science:

    • Endocrinology
    • Ophthalmology
    • Pharmacology

    Background:

    • Elevated intraocular pressure (IOP) is a significant risk factor for glaucoma.
    • The role of endogenous glucocorticoids in IOP regulation remains incompletely understood.

    Purpose of the Study:

    • To investigate the effect of decreased plasma cortisol levels on intraocular pressure.
    • To determine if plasma glucocorticoids influence ocular pressure regulation.

    Main Methods:

    • A double-masked, two-period, crossover trial involving 14 subjects with elevated IOP.
    • Administration of oral metyrapone tartrate (adrenal cortisol biosynthesis inhibitor) and placebo.
    • Monitoring of ocular pressure and adrenal response over a seven-hour period.

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    Main Results:

    • Metyrapone administration resulted in a significantly greater decrease in ocular pressure compared to placebo.
    • Subjects were classified as responders or nonresponders based on IOP decline after metyrapone versus placebo.
    • Responders showed a smaller decrease in IOP over time with placebo and a smaller decrease in plasma cortisol with metyrapone.

    Conclusions:

    • Decreased plasma cortisol levels effectively reduce intraocular pressure.
    • These findings support the hypothesis that plasma glucocorticoids are involved in the regulation of ocular pressure.
    • Individual differences in IOP response may relate to cortisol metabolism and adrenal function.