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The Effect of Psychotropic Medications on Glaucoma Risk and Intraocular Pressure: A Bayesian Meta-Analysis
Tommaso B Jannini1, Ludovico Alisi2, Francesca Giovannetti2
1Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy.
CNS Drugs
|December 13, 2025
Summary
Psychotropic medications can impact glaucoma risk. Benzodiazepines and topiramate are linked to increased glaucoma risk, while SSRIs may offer modest protection. Ophthalmologic monitoring is crucial for patients on these psychiatric drugs.
Area of Science:
- Ophthalmology
- Pharmacology
- Psychiatry
Background:
- Glaucoma is a leading cause of irreversible blindness globally.
- Psychotropic medications are increasingly recognized as potential risk factors for glaucoma.
- Previous studies on psychotropic drug use and glaucoma risk have yielded inconsistent findings.
Purpose of the Study:
- To clarify the association between psychotropic drug use and glaucoma risk.
- To conduct a Bayesian meta-analysis to synthesize existing evidence.
- To evaluate the impact of specific psychotropic drug classes on glaucoma and intraocular pressure (IOP).
Main Methods:
- Systematic literature search conducted up to December 2024.
- Inclusion of observational studies reporting odds ratios (ORs), relative risks (RRs), or mean differences for glaucoma or IOP.
- Application of Bayesian random-effects models with informative priors for quantitative synthesis.
Main Results:
- Analysis of 22 studies with 293,228 psychotropic medication users.
- Selective serotonin reuptake inhibitors (SSRIs) associated with reduced open-angle glaucoma risk (OR=0.832) and IOP (Hedges' g=-0.332).
- Benzodiazepines linked to significantly increased glaucoma risk (OR=1.550); Topiramate strongly associated with acute angle-closure glaucoma (OR=3.930).
- Tricyclic antidepressants did not show a significant association with glaucoma risk.
Conclusions:
- Benzodiazepines and topiramate show a strong association with glaucoma risk.
- Caution is advised due to study heterogeneity and special populations.
- Ophthalmologic monitoring is essential for patients on benzodiazepines or topiramate due to potential glaucoma risks.
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