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

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Abstract

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.

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Authors and Affiliations

  1. The University of New South Wales, Sydney, NSW, Australia

    Neeranjali S. Jain & Claire W. Ruan

  2. Save Sight Institute, University of Sydney, Sydney, NSW, Australia

    Shanil R. Dhanji & Richard J. Symes

  3. Sydney Eye Hospital, Sydney, NSW, Australia

    Neeranjali S. Jain, Shanil R. Dhanji & Richard J. Symes

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  1. Neeranjali S. Jain
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Correspondence to Richard J. Symes.

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Neeranjali S. Jain, Claire W. Ruan, Shanil R. Dhanji, and Richard Symes have no conflicts of interest that are directly relevant to the content of this article.

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NSJ primary manuscript author, literature review and editing. CWR editing. SRD literature review and editing. RS conceptualization, supervisor and editing.

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Jain, N.S., Ruan, C.W., Dhanji, S.R. et al. Psychotropic Drug-Induced Glaucoma: A Practical Guide to Diagnosis and Management. CNS Drugs 35, 283–289 (2021). https://doi.org/10.1007/s40263-020-00790-w

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