Cold and Allergy Medications
After reading package inserts for cold and allergy medications many patients ask if they can take such drugs if they have glaucoma. The answer most of the time is yes; however, these medications can cause pupil dilation and result in a condition called acute angle closure glaucoma. Fortunately, only small subsets of patients are at risk. Determining if you are at risk is particularly important because acute angle closure glaucoma can result in substantial vision loss in just a matter of days.
There are different types of glaucoma. The most common is primary open angle glaucoma or POAG. POAG represents 70% of all glaucoma. In contrast, narrow angle glaucoma only accounts for 10-15% of glaucoma cases. POAG is not affected by cold and allergy medications and therefore these medications are safe to take without potential adverse effects. In narrow angle patients however, these medications can cause the pupil to dilate resulting in blockage of aqueous fluid draining from the eye. In addition, undiagnosed patients with anatomically narrow angles who are unaware of their condition may experience the same result: acute angle closure glaucoma. The only way to know if you have narrow angles and are at risk is to have an eye and vision health evaluation. If you know you have glaucoma, it is important to ask your eye doctor what type you have and absolutely ask before taking any medications when you see this type of warning.
Steroids or Cortisone Products
Steroids are very important drugs used in every area of healthcare. With respect to the eyes, steroids are used for control of inflammation or swelling. They help control potential damage to our eye tissue from an overactive immune system’s response to trauma, infection, or allergies. Patients recognize how much better steroids make their eyes feel and, unfortunately, many times overuse them.
Steroids used topically in the eye, taken orally, or as nasal sprays or inhalants can cause increased eye pressure and potentially open angle glaucoma if used inappropriately or without supervision. If you are taking any steroid containing medication for more than 10 days, you should confer with your optometrist to determine if your eye pressure should be evaluated. The mechanism of steroid induced glaucoma is not fully understood. However, the most common theory is that the drainage tissue of the eye, called trabecular meshwork, is clogged. Steroids cause accumulation of various proteins that build up in the trabecular meshwork and block drainage.
Other Medications
In summary, drug induced glaucoma can occur by two mechanisms; open-angle glaucoma is generally steroid induced, and closed angle glaucoma is generally from pupillary dilation. Many different medications might cause pupil dilation so due diligence in reviewing drug side effects and discussing them with your eye doctor is important.
Various systemic conditions such as asthma, depression, migraines, and Parkinson’s disease require drugs that may produce pupillary dilation and could result in an attack of acute angle closure glaucoma in susceptible patients. Dietary supplements that suppress appetite can also induce acute angle closure glaucoma due to pupillary dilation.
Topamax or topiramate, a drug used in the treatment of epilepsy and the prevention of migraine headaches, may cause acute glaucoma like that seen with angle closure. Fortunately, studies show that with Topamax most cases occur during the first six months of use and then this risk appears to taper off with respect to incidence.
Please contact our office with questions regarding potential ocular side effects of prescription or over-the-counter medications. You can reach us at Cockrell Eyecare Center in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and message us on Instagram and Facebook at Cockrell Eye Care Center!