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Acute angle closure glaucoma presenting in a young patient after administration of paroxetine [14]

July 2000
Eye (London, England) 14 ( Pt 3A)(3):406-8

July 2000
14 ( Pt 3A)(3):406-8

DOI:10.1038/eye.2000.106

Source
PubMed

Authors:

Ken K Nischal

Childrens Hospital of Pittsburgh

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

UBM scan of the patient's left eye showing the anterior displacement of the iris and loss of the ciliary sulcus.

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Perimetric examination of the central 30° with an Octopus Perimeter. A small central island and an accompanying temporal island of vision has remained. MD: +25.6.

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(a) Posteroanterior view left internal carotid angiographic study confirming a large (14 mm) aneurysm pointing superonasally. (b) MR angiogram indicating the presence of an aneurysm arising from the terminal carotid artery just above the cavernous sinus. asymmetry and an arcuate scotoma. During a 3 month follow-up period the intraocular pressure did not differ significantly between the two eyes. She subsequently developed a left RAPD. This was felt to be inconsistent with the previous clinical signs. Unilateral left optic nerve dysfunction was diagnosed and the possibility of optic nerve compression was raised. The presence of a carotid-ophthalmic artery aneurysm, compressing the left optic nerve, was established with MRI.

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UBM scan of the patient's right eye showing the cystic ciliary process/body.

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Figures - uploaded by Ken K Nischal

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Content uploaded by Ken K Nischal

Content may be subject to copyright.

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    

     

      

   

  

  

     





 

    

   

  

  

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   

  



  

 

 



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    

    

    

  

  

 

References

   

  

  



    

   



 

   



    

     

      



    

     



           

    

     

    





 

 

    

   

 

 



   

 

  

 

  

    

  

    

  

  





   

 



 

   











 

    

Case report



    





  





      

  

   

 





   



  



 

  





   

  

   

  



   



   

    

    

 

  

 



   



 







 

 



     





   

   

   

 

    

 

Comment

  

 

  

   



  

    

    

  

    









  



 



 

  



 



 





   

     





   



 





   

   



  



 

     



   

    

   

    

   

    

     

    



References

       

   

      

    



    

    

 





      

     

    

  

       



       

     

 

        

    

     

     

   



     

      

     



        

  

  

 

 

  

  

   

  

     



    

  

   

  

   

 

  

  







      



 



       

   

   

      

   

   

   

   

Case r



ort

   



   

      

     

          

     

     

  

     



      





   

     

     



    

      

     

    

     

     

       





     

    

   

    

   

     

       

         

     

   

     

      

 

       

     

      

+30"

         

     

  

Acute Angle-Closure—A Rare but Vision-Threatening Ocular Adverse Effect of Selective Serotonin Reuptake Inhibitors

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Apr 2021

Acute angle closure (AAC) is a relatively rare but serious ophthalmological condition in which early diagnosis and intraocular pressure (IOP) -lowering treatment play a key role in prognosis. The aim of this review is to present current understanding of the pathophysiology, symptoms, diagnosis, potential mechanisms as well as management of AAC associated with the use of selective serotonin reuptake inhibitors (SSRIs). In most cases, AAC in individuals receiving SSRIs occurs in the pupillary block mechanism, secondary to SSRI-induced mydriasis. However, SSRIs may also cause uveal effusion and, consequently, iridocorneal angle closure. Other factors such as impaired metabolism and elimination of SSRIs, individual genetic conditions, as well as inhibition of SSRIs metabolism due to the effects of other drugs used may also promote AAC.

Acute Primary Angle Closure Caused by Plateau Iris After Ritodrine Use in a Primigravid Woman Successfully Treated With Clear-Lens Extraction: A Case Report

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Full-text available

Feb 2022

Acute primary angle closure (APAC) is rare in young adults (those under approximately 40 years old) and pregnant women. Here, we report the case of a 37-year-old primigravid woman with APAC caused by plateau iris after the use of ritodrine (a β2 stimulator) that was successfully resolved by clear-lens extraction five months after delivery. The patient presented with pain in her right eye after ritodrine infusion for threatened premature labor at 23 weeks of gestation. Her visual acuity was 20/40, and her intraocular pressure (IOP) was 31 mmHg in her right eye. The patient was diagnosed as having APAC with plateau iris based on ultrasound biomicroscopy (UBM) findings of irido-angle touch, anterior dislocation of the ciliary process, and an absent ciliary sulcus. The effectiveness of treatment with pilocarpine eyedrops was limited, and argon laser peripheral iridoplasty did not succeed in reducing IOP. An immediate resolution was achieved with clear-lens extraction. IOP has since stayed within 14-16 mmHg without any medication for seven years. This is the first reported case of APAC complicated with plateau iris after ritodrine use in a pregnant woman. This condition is rare in young adults, making it difficult to diagnose; however, UBM can be of great help. In this case, clear-lens extraction led to a successful outcome. Our case suggests that attention should be paid to drug associations when APAC occurs with plateau iris.

Effects of three months treatment with sertraline on intraocular pressure and cup-to-disc ratio in patients with anxiety disorders/mixed anxiety and depressive disorder/major depressive disorder and without underlying eye disease

Article

Full-text available

Sep 2017

Effects of Selective Serotonin Reuptake Inhibitors on Macular Ganglion Cell Complex Thickness and Peripapillary Retinal Nerve Fiber Layer Thickness

Article

Full-text available

Dec 2017

Purpose: To evaluate macular ganglion cell complex (GCC) thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in patients treated with SSRIs. Methods: The present study included 62 eyes of 31 patients who were using SSRIs and 60 eyes of 30 healthy, age- and gender-matched control subjects. All patients underwent a full ophthalmological examination in which macular thickness, GCC thickness, and peripapillary RNFL thickness were measured using optical coherence tomography (OCT). The Mann–Whitney U test was used to compare the patients’ group with the age- and gender-matched control group. Pearson correlation analyses were also performed to assess the relationships between macular thickness, GCC thickness, RNFL thickness, and the duration of SSRI usage. Results: The mean duration of SSRI usage was 29.96 ± 27.19 (range 6–120) months. The foveal thickness was 253.48 ± 22.77µm in the patients’ group and 266.60 ± 20.64 µm in the control group; the difference between the groups was statistically significant. In addition, the perifoveal GCC thickness in the inferonasal and inferotemporal quadrant were significantly smaller thinner in the patient group (Mann–Whitney U test, p = 0.021and p = 0.013, respectively). Conclusions: Our results suggest a relation between SSRIs and decreased retinal GCC thickness and RNFL thickness. Future long-term prospective studies should elucidate the actual effect of SSRIs on GCC and RNFL thickness.

Effects of Selective Serotonin Reuptake Inhibitors on Intraocular Pressure and Anterior Segment Parameters in Open Angle Eyes

Article

Full-text available

May 2017

Purpose: To evaluate the short and long term effects of selective serotonin reuptake inhibitors (SSRIs) on intraocular pressure (IOP) and anterior segment parameters in open angle eyes. Materials and Methods: This cross-sectional study included 325 eyes of 166 subjects. Subjects were divided into three groups; group 1 included 116 eyes of 58 patients receiving SSRIs for 1 week - 6 months, group 2 included 102 eyes of 53 patients receiving SSRIs for longer than 6 months, and group 3 included 107 eyes of 55 healthy subjects not receiving any drugs. All of the patients receiving SSRIs were diagnosed as major depressive disorder. All groups were chosen to be similar in terms of age and gender. All patients underwent a detailed ophthalmologic examination including IOP measurement by Goldmann applanation tonometer and gonioscopy. Anterior segment parameters including pupil diameter (PD), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) were assessed by a Scheimpflug system. Results: Pupil diameter was significantly larger in patients receiving SSRIs for < 6 months and ≥ 6 months than control subjects (3.53 ± 0.71 mm, 3.48 ± 0.60 mm versus 3.11 ± 0.72 mm, p < 0.05) but this effect was independent from the duration of SSRI treatment. Intraocular pressure was significantly lower in patients receiving SSRIs for < 6 months and ≥ 6 months than control group (16.04 ± 2.17 mmHg, 16.11 ± 2.13 mmHg versus 17.34 ± 2.15 mmHg, p < 0.05) but there were no statistically significant differences between the patients receiving SSRIs for < 6 months and ≥ 6 months. There were no statistically significant differences between the patient and control group in values of CCT, ACD, ACV, and ACA. Anterior chamber angles were measured between 25° - 55° with Scheimpflug system and also classified as grade 3-4 (Shaffer system) by gonioscopy. Conclusions: Selective serotonin reuptake inhibitors cause mydriasis which is persistent during the treatment. In depression patients with open angle eyes, short and long term use of SSRIs leads to decrease in IOP.

Psychopharmacological Treatment, Intraocular Pressure and the Risk of Glaucoma: A Review of Literature

Article

Full-text available

Jun 2021

Through the years, the available psychopharmacological treatments have expanded with numerous new drugs. Besides weight gain, gastro-intestinal problems or Parkinson-like symptoms, ocular adverse effects of psychiatric drugs have been reported. These adverse effects are not common, but can be dangerous for the patient. This review summarises the current knowledge on the risk of raised intraocular pressure and glaucoma entailed by psychopharmacological treatment. Also, it provides updated data for clinicians involved in the treatment of patients with glaucoma or glaucoma risk factors. For this purpose, we performed an extensive literature search in the PubMed database using specific terms. Selective serotonin and noradrenaline reuptake inhibitors are the best evidenced as having no association with glaucoma. Antipsychotics, and especially first generation, seem to have no correlation with an increased intraocular pressure and therefore possibly with a risk of glaucoma, although a special attention should be paid when using ziprasidone. Tricyclic antidepressants, benzodiazepines and topiramate should be avoided in patients diagnosed with glaucoma or at risk. Clinicians should be aware of the possible psychotropic drug induced glaucoma and monitor at risk patients closely in order to prevent this condition. Irrespective of the psychopharmacological regimen taken into consideration, the glaucoma patient should be under the strict supervision of the ophthalmologist.

Psychotropic Drug-Induced Glaucoma: A Practical Guide to Diagnosis and Management

Article

Feb 2021

This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals with an Asian background. These patients may benefit from a laser peripheral iridotomy, either prophylactically or to relieve an acute angle-closure episode. An idiosyncratic reaction to medications such as topiramate may lead to angle closure through an alternate mechanism, leading to a uveal effusion. Ophthalmological review may be considered prior to commencing medications in high-risk patients.

Bilateral acute angle closure caused by supraciliary effusions associated with venlafaxine intake

Article

Feb 2005

Acute Angle Closure Glaucoma Associated with Aripiprazole in the Setting of Plateau Iris Configuration

Article

Nov 2017
J GLAUCOMA

Purpose of the study: To report a novel case of drug-induced angle-closure from aripiprazole (Abilify), an atypical antipsychotic, and propose a mechanism for this association. Methods/results: We report a case of a 45 year-old Caucasian woman who presented in subacute angle closure two months after initiating aripiprazole 5 mg daily for depression. This patient reported no prior ocular history and had been on longstanding duloxetine (Cymbalta) 60 mg daily for over ten years prior to starting aripiprazole. Examination at initial presentation revealed an intraocular pressure (IOP) of 16 mm Hg in the right eye and an elevated IOP of 44 mm Hg in the left eye. Gonioscopy demonstrated a plateau iris configuration in the right eye and angle closure with a plateau iris configuration in the left eye. She was started on IOP-lowering therapy and underwent a laser peripheral iridotomy. Despite recommendation to discontinue aripiprazole, duloxetine was discontinued; aripiprazole was maintained and later increased to 10 mg daily for worsening depression. Three months after the dosage increase, the patient was found to have an elevated IOP of 32 mm Hg and angle-closure with a plateau iris configuration in the left eye. Iridoplasty was performed in the left eye with subsequent opening of the angle and improvement in IOP. The second attack of angle-closure led to the discontinuation of aripiprazole and a corresponding widening of the angles in both eyes one week after cessation. Conclusion: This is the first report to describe drug-induced angle closure glaucoma associated with aripiprazole use. The mechanism of angle closure, we hypothesize, is from mydriasis and/or supraciliary effusion mediated by the serotoninergic effect on the iris and ciliary body complex. Treatment is preferably cessation of the medication. However, in cases where the medication is necessary for management of major depression, iridoplasty should be performed to reduce the risk of angle closure.

Bilateral angle-closure glaucoma secondary to selective serotonin reuptake inhibitor

Article

May 2006

Pupillary dysfunction in macular disease

Article

Full-text available

Feb 1980
Trans Am Ophthalmol Soc

Serotonin and melatonin in the iris/ciliary processes and their involvement in intraocular pressure

Article

Full-text available

Feb 1994

N N Osborne

From the evidence available it is clear that melatonin and serotonin receptors exist in the iris/ciliary processes of the rabbit. These receptors may be involved in maintaining the intraocular pressure (IOP). However, the published results on this point are often contradictory, perhaps because of the variation in the species of animals used and the methodology employed. It is also clear that the data obtained from studies on the rabbit cannot be directly applied to man. Nevertheless, present information points to the possibility that drugs influencing specific serotonin and/or melatonin receptors may be used to influence IOP in man and thus have a therapeutic effect.

Plateau Iris Syndrome Associated With Multiple Ciliary Body Cysts

Article

Jun 1996
ARCH OPHTHALMOL-CHIC

Augusto Azuara-Blanco

Objective: To describe plateau iris syndrome associated with multiple neuroepithelial cysts of the pars plicata.Methods: Case reports of 3 patients with plateau iris syndrome who were found to have multiple bilateral ciliary body cysts on ultrasound biomicroscopic examination.Results: Ultrasound biomicroscopy revealed classic features of plateau iris syndrome in each patient but also showed multiple neuroepithelial cysts of the ciliary body in each eye.Conclusion: Plateau iris syndrome may be associated with multiple ciliary body cysts.

Pathology and Pathogenesis of Intracranial Saccular Aneurysms

Article

Sep 1984

William McCormick

Carotid-ophthalmic aneurysms - A series of 16 cases treated by direct approach

Article

Dec 1970

A series of 16 cases of carotid-ophthalmic aneurysm treated by direct approach is reported and the following points are emphasized: the aneurysm was associated with signs of optic nerve compression in half of the cases. angiography did not always disclose the possibilities and the hazards of direct surgery. indirect surgery (common carotid ligation) did not prevent the aneurysm from growing or restore useful vision. On the other hand, ligation of the aneurysmal neck or local trapping, where necessary, followed by removal of the aneurysm resulted in marked improvement of impaired vision. The hazard of ophthalmic artery occlusion is stressed.

Pavlin CJ, Ritch R, Foster FS. Ultrasound biomicroscopy in plateau iris syndrome

Article

May 1992
AM J OPHTHALMOL

Ultrasound biomicroscopy is a new technique that uses high-frequency ultrasound (50 to 100 MHz) to produce images of the entire anterior segment at high resolution (20 to 50 microns). The iridocorneal angle, iris, ciliary body, and posterior chamber can be imaged in detail and the dimensions and anatomic relationships of these structures determined. Plateau iris syndrome is a condition in which the angle remains appositionally closed or occludable after iridectomy for angle-closure glaucoma. How the iris remains in a position that allows it to occlude the angle has been uncertain. We performed ultrasound biomicroscopy eye examinations on eight patients with clinically diagnosed plateau iris syndrome. In all the patients, ciliary processes were situated anteriorly compared to the position in normal subjects and in patients with angle closure caused by pupillary block. The ciliary processes provide structural support beneath the peripheral iris, preventing the iris root from falling away from the trabecular meshwork after iridectomy.

[Action of indalpine on the pupil diameter in the healthy volunteer]

Article

Jan 1985

Indalpine is a potent inhibitor of 5 HT uptake into central neurones with antidepressive properties; mydriasis is observed after a single oral dose of 25 mg. The miosis evoked by locally instilled pilocarpine is not modified by indalpine. There is a potentiation of the response of locally instilled adrenaline. It is suggested that indalpine has no anticholinergic effect. The potentiation of mydriasis evoked by adrenaline may reflect the blockade of the uptake of catecholamine into adrenergic nerve terminals.

The Clinical Pharmacology and Use of Paroxetine, a New Selective Serotonin Reuptake Inhibitor

Article

Apr 1994

Charles B. Nemeroff

Major depression afflicts a significant percentage of the population, and optimum therapy is often limited by the poor tolerability and lethality in overdose of the tricyclic antidepressants. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline, and, more recently, paroxetine are viewed as welcome additions to existing therapy. The SSRIs are as effective as the tricyclic antidepressants, but are not associated with their adverse effect profile. Paroxetine in dosages of 20-50 mg/day is as effective as the older classic antidepressants, including amitriptyline, imipramine, and doxepin. It is effective in the elderly and in patients with recurrent, resistant, or severe depression.

The Presence of Serotonin (5-HT1) Receptors Negatively Coupled to Adenylate Cyclase in Rabbit and Human Iris-Ciliary Processes

Article

Sep 1993

Serotonin (5-hydroxytryptamine, 5-HT) reduces forskolin-induced stimulation of cyclic AMP in rabbit iris-ciliary body (ICB) homogenates. The effect is dose dependent and can be mimicked by a number of 5-HT1 receptor agonists including 5-carboxamidotryptamine (5-CT) and RU 24969 [5-methoxy-3-(1,2,3,6, tetrahydro-4-pyridinyl)-1-indole]. The inhibitory effects of 5-CT and the 5-HT1A selective agent 8-hydroxy-2-(di-n-propyl-amino) tetralin (8-OH-DPAT) on forskolin stimulated adenylate cyclase activity are greater in isolated ciliary processes than in the iris musculature. Spiperone and propranolol significantly antagonize the action of 5-CT in the iris-ciliary body, while ketanserin (5-HT2 antagonist) and ICS 205930 (5-HT3/4 blocker) were without influence, indicating the presence of the 5-HT1A subtype of receptor. Studies carried out on human ICB homogenates also suggest the presence of 5-HT1A-like receptors, although these receptors are not identical to those in rabbit. Similarities include dose-dependent decreases in cAMP levels stimulated by forskolin elicited by 1-(3-chlorophenyl) piperazine (mCPP), 5-CT and 8-OH-DPAT. Moreover, the inhibitory effect of 5-CT can also be significantly reduced by the 5-HT1 receptor antagonist, propranolol. However, unlike the case of rabbit tissue, spiperone was ineffective in abolishing the 5-CT response in human ICB homogenates.

Plateau iris syndrome associated with multiple ciliary body cysts: Report of 3 cases

Article

Jul 1996
ARCH OPHTHALMOL-CHIC

To describe plateau iris syndrome associated with multiple neuroepithelial cysts of the pars plicata. Case reports of 3 patients with plateau iris syndrome who were found to have multiple bilateral ciliary body cysts on ultrasound biomicroscopic examination. Ultrasound biomicroscopy revealed classic features of plateau iris syndrome in each patient but also showed multiple neuroepithelial cysts of the ciliary body in each eye. Plateau iris syndrome may be associated with multiple ciliary body cysts.

Acute angle closure glaucoma presenting in a young patient after administration of paroxetine [14]

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