Special considerations druginduced glaucomas

Medications have the potential to cause or exacerbate both POAG and PACG; however, PACG is more likely to be exacerbated by medications than POAG. The use of medications with anticholinergic or sympathomimetics properties can precipitate angle closure. Sulfa-based drugs cause swelling of the ciliary body, which causes an anterior displacement of the lens resulting in a decrease in anterior-chamber depth. Controlled POAG is rarely exacerbated by anticholinergics, sympathomometics, and sulfa-based drugs unless the patient is concomitantly at risk for angle closure. For uncontrolled or untreated POAG, the risk-benefit should be considered before employing these agents. POAG can be exacerbated by corticosteroids. Corticosteroids increase IOP by causing obstruction of the trabecular meshwork with extracellular material. The increase in IOP appears to increase with potency and intraocular penetration. Ophthalmic corticosteroid preparations carry the highest risk of increasing IOP.12

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