title: Drug-induced Bilateral Secondary Angle-Closure Glaucoma: A Literature Synthesis.
abstract: OBJECTIVE
  We performed a literature synthesis to identify the full spectrum of compounds implicated in drug-induced, bilateral secondary angle-closure glaucoma (2° ACG).
  
  
  METHODS
  Systematic PubMed literature review identified relevant bilateral 2° ACG case reports. We evaluated these reports with both the Naranjo adverse drug reaction probability scale to assess the causality of reported drug reactions and a 2° ACG scale scoring system we developed to determine the likelihood that the event represented bilateral 2° ACG. Two independent graders performed these analyses and their scores were averaged for interpretation. The Naranjo scale ranges from -4 to +13 and the drug reaction was considered definite if the score was ≥ 9, probable if 5 to 8, possible if 1 to 4, and doubtful if ≤ 0. The 2° ACG score ranges from 0 to 7. We considered a 2° ACG score of ≥ 4 as evidence of significant likelihood that the drug reaction represented bilateral 2° ACG.
  
  
  RESULTS
  No drug had a definite Naranjo score, but the following drug entities had probable Naranjo scores and 2° ACG scores ≥ 4: acetazolamide, "anorexiant mix," bupropion, cabergoline, "ecstasy," escitalopram, flavoxate, flucloxacillin, hydrochlorothiazide, hydrochlorothiazide/triamterene, mefenamic acid, methazolamide, oseltamivir, topiramate, topiramate/bactrim, and venlafaxine. Root chemical analysis revealed that sulfur-containing and non-sulfur-containing compounds contributed to bilateral 2° ACG.
  
  
  CONCLUSIONS
  Several compound preparations were implicated in drug-induced bilateral 2° ACG. Treating physicians should be aware that some forms of recreational drug use, which the patient may not admit to, could contribute to this vision-threatening side effect.
authors.affiliation: *School of Medicine, University College Dublin, Dublin, Ireland †Department of Ophthalmology, Massachusetts Eye and Ear Infirmary ‡Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Rory M
authors.initials: RM
authors.lastname: Murphy
authors.forename: Belal
authors.initials: B
authors.lastname: Bakir
authors.forename: Colm
authors.initials: C
authors.lastname: O'Brien
authors.forename: Janey L
authors.initials: JL
authors.lastname: Wiggs
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pasquale
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology* / Q000503:physiopathology; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D011336:Probability