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Drug-Induced Glaucoma Treatment & Management

  • Author: Douglas J Rhee, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jul 29, 2014
 

Medical Care

See the list below:

  • Open angle
    • If the patient's underlying medical condition can tolerate discontinuation of corticosteroids, then cessation of the medication will usually result in normalization of IOP.
    • In the case of topical corticosteroid drops, using a lower potency steroid medication, such as the phosphate forms of prednisolone and dexamethasone, rimexolone, loteprednol etabonate, fluorometholone, or medrysone, should be considered. These lower potency drugs have a lesser chance of raising IOP, but they are usually not as effective as an anti-inflammatory drug. Topical nonsteroidal anti-inflammatory medications (eg, diclofenac, ketorolac) are other alternatives that have no potential to elevate IOP, but they may not have enough anti-inflammatory activity to treat the patient's underlying condition.
    • In the occasional cases in which the patient's IOP does not normalize upon cessation of the steroid or in those patients who must continue on corticosteroid medications, use standard antiglaucoma medications, as described in Glaucoma, Primary Open Angle.
  • Closed angle
    • If the etiology is because of sulfa containing medications, the increase in IOP generally will resolve upon stopping the medication. However, severe cases of sulfonamide-induced angle closure (ie, IOP >45 mm Hg) may not respond to simply discontinuing the offending medication. These cases may respond to intravenous Solu-Medrol and mannitol.
    • For other etiologies, treat the same as primary acute angle-closure glaucoma.
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Surgical Care

See the list below:

  • Open angle
    • When medical therapy is ineffective at lowering the IOP to target pressure or the patient is intolerant of medical therapy, then surgical therapy is indicated.
    • In patients with an open angle and the absence of ocular inflammation, argon laser trabeculoplasty can be attempted to lower the IOP.
    • In patients whom both medical and laser therapy have failed to lower the IOP adequately, surgical therapy is warranted. Usually, trabeculectomy (guarded filtration procedure), with or without intraoperative antimetabolites, is the primary procedure. In cases of eyes with active neovascularization or inflammation, a glaucoma drainage implant may be used as the primary procedure.
  • Closed angle: Treat the same as primary acute angle-closure glaucoma.
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Consultations

If not able to control IOP, refer the patient to a glaucoma specialist.

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Contributor Information and Disclosures
Author

Douglas J Rhee, MD Chair and Professor, Department of Ophthalmology and Visual Science, University Hospitals Eye Institute, Case Western Reserve University School of Medicine

Douglas J Rhee, MD is a member of the following medical societies: Alpha Omega Alpha, Association for Research in Vision and Ophthalmology, American Glaucoma Society, American Academy of Ophthalmology, American Medical Association, Phi Beta Kappa

Disclosure: Received grant/research funds from Alcon for independent contractor; Received grant/research funds from Allergan for independent contractor; Received consulting fee from Alcon for consulting; Received consulting fee from Allergan for consulting; Received grant/research funds from Merck for independent contractor; Received grant/research funds from Ivantis for independent contractor; Received consulting fee from Glaukos for consulting; Received consulting fee from Ivantis for consulting; Received.

Coauthor(s)

Steven Gedde, MD Program Director, Assistant Professor, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine

Steven Gedde, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Michael D Greenwood, MD Fellow, Vance Thompson Vision

Michael D Greenwood, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew I Rabinowitz, MD Director of Glaucoma Service, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, American Society for Laser Medicine and Surgery, American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.

References
  1. Rudkin AK, Gray TL, Awadalla M, Craig JE. Bilateral simultaneous acute angle closure glaucoma precipitated by non-prescription cold and flu medication. Emerg Med Australas. 2010 Oct. 22(5):477-9. [Medline].

  2. Hwang JC, Khine KT, Lee JC, Boyer DS, Francis BA. Methyl-Sulfonyl-Methane (MSM)-induced Acute Angle Closure. J Glaucoma. 2013 Nov 14. [Epub ahead of print]:

  3. Razeghinejad MR, Pro MJ, Katz LJ. Non-steroidal drug-induced glaucoma. Eye (Lond). 2011 Aug. 25(8):971-80. [Medline]. [Full Text].

  4. Armaly MF. Effect of corticosteroids on intraocular pressure and fluid dynamics. I. The effect of dexamethasone in the normal eye. Arch Ophthalmol. 1963. 70:482.

  5. Armaly MF. Effect of corticosteroids on intraocular pressure and fluid dynamics. II. The effect of dexamethasone in the glaucomatous eye. Arch Ophthalmol. 1963. 70:492.

  6. Nguyen N, Mora JS, Gaffney MM, et al. A high prevalence of occludable angles in a Vietnamese population. Ophthalmology. 1996 Sep. 103(9):1426-31. [Medline].

  7. Ohji M, Kinoshita S, Ohmi E, et al. Marked intraocular pressure response to instillation of corticosteroids in children. Am J Ophthalmol. 1991 Oct 15. 112(4):450-4. [Medline].

  8. Panday VA, Rhee DJ. Review of sulfonamide-induced acute myopia and acute bilateral angle-closure glaucoma. Compr Ophthalmol Update. 2007 Sep-Oct. 8(5):271-6. [Medline].

  9. Polansky JR. Side effects of ophthalmic therapy with anti-inflammatory steroids. Curr Opin Ophthalmol. 1992. 3:259-272.

  10. Rhee DJ, Peck RE, Belmont J, et al. Intraocular pressure alterations following intravitreal triamcinolone acetonide. Br J Ophthalmol. 2006 Aug. 90(8):999-1003. [Medline].

  11. Rhee DJ, Ramos-Esteban JC, Nipper KS. Rapid resolution of topiramate-induced angle-closure glaucoma with methylprednisolone and mannitol. Am J Ophthalmol. 2006 Jun. 141(6):1133-4. [Medline].

  12. Wolfs RC, Grobbee DE, Hofman A, et al. Risk of acute angle-closure glaucoma after diagnostic mydriasis in nonselected subjects: the Rotterdam Study. Invest Ophthalmol Vis Sci. 1997 Nov. 38(12):2683-7. [Medline].

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