Bilateral simultaneous acute angle closure glaucoma precipitated by non-prescription cold and flu medication.
We present a case of a 63-year-old woman who presented to an ED with bifrontal headache, nausea and vomiting and reduced visual acuity. Examination revealed bilateral elevated intraocular pressures, corneal haze, shallow anterior chambers and poorly reactive, mid-dilated pupils. Diagnosis was made of simultaneous bilateral acute angle closure glaucoma. A complete drug history revealed that she had been using an over-the-counter cold and flu remedy whose active ingredients included atropa belladonna, an herb with anticholinergic properties. It is likely that drug-induced dilatation of the individual's pupils precipitated this angle closure emergency. In the report we discuss the risk factors for angle closure glaucoma, and review the local and systemic drugs known to trigger this sight-threatening emergency.
Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, Australia. rudkin.adam@gmail.com
Adam K
AK
Rudkin
Tim L
TL
Gray
Mona
M
Awadalla
Jamie E
JE
Craig
D000086:Acetazolamide / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001532:Atropa belladonna / Q000009:adverse effects*; D003139:Common Cold; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007251:Influenza, Human; D008875:Middle Aged; D057985:Multi-Ingredient Cold, Flu, and Allergy Medications / Q000009:adverse effects*; D018721:Muscarinic Agonists / Q000627:therapeutic use; D010862:Pilocarpine / Q000627:therapeutic use; D028321:Plant Preparations / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors; D013999:Timolol / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D057985:Multi-Ingredient Cold, Flu, and Allergy Medications; D018721:Muscarinic Agonists; D028321:Plant Preparations; D010862:Pilocarpine; D013999:Timolol; D000086:Acetazolamide