It’s natural to reach for over-the-counter (OTC) allergy medications for relief when sneezing, congestion, and itchy, watery eyes make you miserable, but there are certain dangers to taking OTC allergy drugs when you have glaucoma. Learn more here about which medications, in which forms (pill, nasal spray, liquid, eye drop), are potentially problematic.

Dangers of OTC for glaucoma patients and those at risk

Many OTC cold medications contain ingredients that induce pupil dilation, which can lead to angle closure in patients who are susceptible. Drug-induced acute angle-closure glaucoma (AACG) is a severe, and potentially sight-threatening, medical emergency that can quickly lead to blindness if not promptly treated. Unlike the more common primary open-angle glaucoma (POAG), AACG can cause sudden attacks of symptoms that may include:

• Extreme eye pain 
• Headache  
• Blurred vision 
• Halos around light sources 
• Nausea and/or vomiting 

The eye constantly produces and sheds fluid called aqueous humor. The drainage angle is the point at which the cornea and iris meet. An angle that is too narrow, or blocked completely, prevents proper fluid drainage. This causes fluid to build up and increase pressure from inside the eye. 

Who is most at risk?

While POAG is the most common form, representing 70% of all glaucoma cases, OTC allergy and cold medications don’t generally have a negative effect on people with POAG.

They can, however, trigger severe and sight-threatening emergencies in people with narrow-angle glaucoma, which accounts for only 10% to 15% of glaucoma cases. If you know you have glaucoma, it’s essential to ask your doctor what type you have, and consult with them before taking these types of medications.

Steroids and cortisone 

Many allergy medications and decongestants also contain corticosteroids, compounds used to calm inflammation caused by overactive immune responses to allergens or infections. Ophthalmic steroids can be used:

• Topically as eye drops, ointments, or gels 
• As nasal sprays or inhalants
• Orally, as pills

Steroids can increase eye pressure, however, and potentially cause open-angle glaucoma if misused. According to Mark Werner, M.D., you should consult your ophthalmologist regarding your eye pressure if you have been taking any medications containing steroids for more than 10 consecutive days. 

Be cautious and take smart action 

While angle-closure glaucoma and steroid-induced glaucoma are rare in the United States, it’s important to be aware of the potential risks. “Prompt diagnosis and effective treatment are critical to preserving vision in an acute attack,” Werner writes. Before using OTC cold or allergy medications, he cautions, “Learn if you’re at risk and check with your healthcare team.” 

*Werner, M. (2022, June 10). When People With Glaucoma Should Avoid Allergy and Decongestant Medications. Glaucoma Research Foundation. https://glaucoma.org/when-people-with-glaucoma-should-avoid-allergy-and-decongestant-medications/