When allergies make you feel miserable and congested, many people reach for over-the-counter (OTC) allergy and decongestant medications — whether in pill, liquid form, or nasal sprays — at their local pharmacy. However, some people with glaucoma must be cautious about taking certain OTC drugs.
That’s because some of these medications include ingredients that can cause pupil dilation resulting in a condition called acute angle-closure glaucoma in susceptible patients.
What Is Acute Angle-Closure Glaucoma?
Drug-induced acute angle-closure glaucoma (AACG) is a severe, often painful, and potentially sight-threatening emergency that can result in blindness if not promptly relieved. In addition, it may result in severe eye pain, headache, blurred vision, Haloes, and nausea or vomiting. Unlike the slow, painless increase in pressure associated with the most common form of glaucoma, primary open-angle glaucoma (POAG), acute attacks of AACG happen suddenly and with no warning.
The eye constantly produces and drains fluid called aqueous humor. The drainage angle is the part of the eye where the cornea and iris meet and where the aqueous humor drains out of the eye. Depending on the shape of the eye, the angle may be relatively narrow, making it more prone to angle closure.
AACG occurs when the angle closes, blocking the drainage of aqueous humor and increasing pressure. In addition, the key ingredients of many OTC cold medications can induce pupil dilation, occasionally leading to angle closure in susceptible patients.
Who Is at Risk?
There are several different types of glaucoma. However, POAG is most common, representing 70% of all glaucoma. Generally, OTC allergy and cold medications won’t negatively affect people with POAG.
However, OTC allergy and cold medications can trigger severe and potentially sight-threatening emergencies in people with narrow-angle glaucoma, which only accounts for approximately 10% to 15% of glaucoma cases.
If you know you have glaucoma, it’s essential to ask your eye doctor what type you have and consult with them before taking these types of OTC medications.
Undiagnosed glaucoma patients with anatomically narrow angles who are unaware of their condition may be at risk of acute angle-closure glaucoma. An eye and vision health evaluation is the only way to determine if you’re at risk.
Steroids or Cortisone Products
Many allergy medications and decongestants also include steroids or cortisone products. Steroids control inflammation or swelling caused by an overactive immune system’s response to infection or allergens. However, steroids used topically in the eye, taken orally, or as nasal sprays or inhalants can cause increased eye pressure and potentially open-angle glaucoma if misused or used without supervision.
If you take any steroid-containing medication for more than ten days, you should check with your eye care provider to determine if your eye pressure should be evaluated. While the mechanism of steroid-induced glaucoma is not fully understood, the most common theory is that the ocular drainage tissue is clogged because steroids cause the accumulation of various proteins that build up and block drainage.
Protect Yourself From These Rare Conditions
Although ACG and steroid-related glaucoma are relatively uncommon conditions in the US that account for only a tiny portion of all diagnosed cases of glaucoma, glaucoma patients must be aware of the potential risks. Prompt diagnosis and effective treatment are critical to preserving vision in an acute attack. Learn if you’re at risk and check with your healthcare team before using any OTC allergy or cold medications.
Help Us Find a Cure
While there’s no cure for glaucoma, advancements in glaucoma research continue to bring us closer to finding a cure and restoring vision loss from glaucoma. You can help find a cure with cash, stock, or a vehicle or boat donation. Your support will give hope to those living with glaucoma and accelerate our search for a cure and vision restoration.
Posted on June 10, 2022; Reviewed for medical accuracy by Mark Werner, MD
Mark Werner, MD
Dr. Mark Werner is an ophthalmologist and glaucoma specialist caring for patients at Delray Eye Associates in Delray Beach, Florida.