Blinded by pressure and pain

Although acute angle closure glaucoma is relatively common, it rarely presents bilaterally. It is characterised by high intraocular pressure resulting in optic nerve damage, and usually presents with nonspecific symptoms such as headache and gastrointestinal upset. It can be even subtler if it prese...

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Bibliographic Details
Published in:The Lancet (British edition) 2005-06, Vol.365 (9478), p.2244-2244
Main Authors: Rahim, Sherali A, Sahlas, Demetrios J, Shadowitz, Steven
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Antihypertensive Agents - adverse effects
Biological and medical sciences
Diuretics - adverse effects
Female
General aspects
Glaucoma
Glaucoma, Angle-Closure - chemically induced
Glaucoma, Angle-Closure - complications
Glaucoma, Angle-Closure - diagnosis
Headache - etiology
Humans
Hydrochlorothiazide - adverse effects
Medical sciences
Medical treatment
Pain
Stress
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Summary:Although acute angle closure glaucoma is relatively common, it rarely presents bilaterally. It is characterised by high intraocular pressure resulting in optic nerve damage, and usually presents with nonspecific symptoms such as headache and gastrointestinal upset. It can be even subtler if it presents subacutely. Bilateral acute angle closure glaucoma is usually due to a drug reaction. Adrenergic agonists, cholinergic agents, anticholinergics, selective serotonin reuptake inhibitors, antihistamines, ACE inhibitors, warfarin and sulfonamide-based drugs have all been implicated in precipitating or causing unilateral or bilateral acute angle closure glaucoma.2 Of the sulfonamide-based drugs, topiramate, an antiepileptic medication, is the most commonly reported cause.2 The timing of our patient's use of hydrochlorothiazide and the onset of her symptoms make a probable link between the two.3 We found 2 previously reported cases of bilateral acute angle closure glaucoma due to hydrochlorothiazide, a widely used sulfonamide-based antihypertensive.4,5 An idiosyncratic allergic reaction with ciliary body swelling and lens thickening that prevents drainage of the anterior chamber, resulting in increased intraocular pressure (figure) is thought to be the cause. Drug-induced acute angle closure glaucoma is treated by lowering the intraocular pressure medically, stopping the offending agent and doing a peripheral laser iridotomy when necessary. Acute angle closure glaucoma is an important, if uncommon, cause of headaches, as it must be treated urgently to prevent permanent visual loss.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(05)66785-2