Acute Glaucoma with Citalopram
Author(s): Rohit Sharma
Abstract
Although there is no mention of acute glaucoma on the list of side effects of citalopram in some patient information leaflets, here have been previous published case reports on association of citalopram and other ssr is (selective serotonin reuptake inhibitors) with acute glaucoma. It is the most severe SSR that is related to ocular complications.
Risk factor: race-Asian origin, hypermetropia, family history, female gender, age, and shallow anterior chamber. The mechanism of SSRI induced acute glaucoma is not clear. An elderly lady with no previous history of glaucoma presented with acute headaches, bilateral ocular pain, photophobia, worsening vision, and fixed dilated pupils. With bilateral raised intraocular pressures she was initially treated with systemic acetazolamide, ocular hypotensives then bilateral YAG iridotomy. Subsequently stopped acetazolamide and pilocarpine.she returned with worsening vision and significantly raised iops this time. Her ultrasound b-scans remained unremarkable (though sometimes they can show typical findings).she was discussed with a glaucoma specialist (rs) who asked for a full drug history and who stopped the oral citalopram subsequently. Her IPOS normalized improving her symptoms and vision markedly. This patient had been seen a few times earlier , however, a comprehensive drug history was not obtained earlier. A low threshold for drug induced causes of bilateral acute glaucoma, including this as side effect in pils (patient information leaflet) and detailed ophthalmic examination including gonios copy should be carried out even in the presence of patent iridotomies in high risk patients.
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