10 September 2024
BMJ Case Reports authors have highlighted the importance of taking a complete drug history after a patient developed acute angle closure glaucoma from over-the-counter medication.
Clinicians from University Hospitals of Leicester NHS Trust shared that a woman in her 60s presented to eye casualty after she developed a severe headache, bilateral eye pain and blurred vision.
The symptoms occurred one hour after taking a cold and flu medicine containing paracetamol, guaifenesin and phenylephrine hydrochloride.
Further investigation revealed that the patient’s intraocular pressures (IOPs) were 75 mm Hg in the right eye and 79 mm Hg in the left eye. The patient had bilateral corneal oedema.
Her visual acuity was 6/18 with glasses in the right eye and 6/24 with glasses in the left eye. She had mild nuclear sclerotic cataract bilaterally.
Following presentation, the patient stopped using the cold and flu medication. She was given IOP-lowering medications alongside 500 mg intravenous acetazolamide, pilocarpine 2% eye drops and dexamethasone preservative-free eye drops.
At a follow-up appointment with the glaucoma clinic two weeks after her initial presentation, the patient was put on the waiting list for cataract surgery and lens implantation to reduce the risk of future angle closure.
Her visual acuity had improved with glasses to 6/7.5 right eye and 6/15 in the left eye.
Within a patient perspective included in the report, the woman shared: “My eyesight has recovered to almost what it was before and I am able to do normal activities.”
The authors emphasised that clinicians should be aware that angle closure is a rare side effect of over-the-counter cold and flu medications.
“A complete drug history is imperative, as a single dose of over-the-counter cold and influenza medication can precipitate acute angle closure,” they shared.
Comments (2)
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Nicholas Rumney27 September 2024
Surely ALL optometry practices have Phenylephrine drops for dilation but I'm not sure that's the point, the anatomical risk factors must also have been there before taking these flu meds. Be interested to note i) ethnicity (Asian/South Asian much more susceptible to ACG ii) Rx (?hyperope) and anatomy iii) when was last EE and was it an EE or a ST. Can't help feeling we may see more of these given the current RCO guidance on managing shallow chambers / narrow angles in the community. UK RCO guidance on AC management is much more non-interventional than any other health system and very dependant on community optoms (without any logic that the GOS is suitable to monitor). Is this evidence based or simply a reflection of the arcane NHS system ?
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Shammy20 September 2024
It would be helpful to know the exact name of the medication so that we can advise patients that have narrow angles. It would also be interesting to know which part of the medication may have caused the CAG - It has three parts to it.
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