Glaucoma patients who also live with other medical conditions should be aware that many common medications can potentially harm their eye health. To make managing glaucoma easier, the American Academy of Ophthalmology (AAO) outlines common over-the-counter and prescription drugs that glaucoma patients should be especially cautious with.*

Confirm your glaucoma type

First, AAO says, it’s important to know which type of glaucoma you have. There are two basic types: open-angle glaucoma, which is the most common form, and closed-angle glaucoma (also called angle-closure glaucoma).

• A medication may be safe for open-angle glaucoma but risky for closed-angle glaucoma, and vice-versa.

States AAO’s J. Kevin McKinney, M.D., “The overwhelming majority of warnings on drug labels read: ‘Don’t take if you have glaucoma’ without specifying the type of glaucoma they’re referring to.” 

Steroids and open-angle glaucoma

Open-angle glaucoma involves gradual vision loss, from the periphery of the eye toward the center, over many years. Steroids are the principal threat to people with this type of glaucoma, says McKinney. Whether oral, topical, inhaled, or intravenous, steroids can raise eye pressure, damaging the optic nerve.

• The greatest threat is from steroids applied near the eyes, whereas
• Oral or intravenous steroids enter the bloodstream and then the eye.

“Steroids applied on or around the face, or inhaled through the mouth or nose, are usually riskier than steroids injected into joints by an orthopedist,” says McKinney.

AAO advises people with open-angle glaucoma to make sure their eye doctor is aware of any steroid use for conditions such as arthritis, allergies, autoimmune disorders, etc., and to keep follow-up appointments so that your eye pressure can be regularly monitored.

Common drugs and closed-angle glaucoma

Acute angle-closure glaucoma involves a sudden blockage of the eye’s drainage angle, and is an emergency situation requiring immediate medical attention to relieve eye pressure and prevent blindness. People with a narrowing drainage angle are at risk for acute angle-closure. 

McKinney says most drug warnings are for those at risk of acute angle-closure glaucoma. Often, people with a narrow angle who develop an acute situation from these medications are taking three or more risky drugs at a time—the higher the number the greater the risk. 

“It’s likely that the last drug they add becomes the straw that breaks the camel’s back and throws them into angle closure.”

A partial list of common drugs that can adversely impact people with narrow angles includes: 

• Allergy-relief and decongestant drugs Allegra® (fexofenadine), Benadryl® (diphenhydramine), Claritin® (loratadine), and ZYRTEC® (cetirizine)
• Asthma and chronic obstructive pulmonary disease (COPD) drugs Atrovent® (ipratropium bromide) and Spiriva® (tiotropium bromide)
• Botulinum toxin, or BOTOX®, injections around the eyes
• Cold/flu remedies that have decongestants and antihistamines such as Alka-Seltzer PLUS® (regular Alka-Seltzer is safe for glaucoma) and DayQuil/NyQuilTM
• Depression/anxiety drugs Cymbalta® (duloxetine), Elavil® (amitriptyline), PaxilTM (paroxetine), and Prozac® (fluoxetine)
• Eye dilation drops used during eye exams
• Gastrointestinal drugs Tagamet® (cimetidine) and Zantac® (ranitidine)
• Incontinence/overactive bladder drugs Detrol® (tolterodine) and Ditropan® (oxybutynin)
• Migraine drug ImitrexTM (sumatriptan)
• Motion sickness scopolamine patches that can be harmful with accidental eye contact, as well as Dramamine® (dimenhydrinate) motion sickness pills (an antihistamine)
• Muscle spasm drug Norflex® and Parkinson’s disease drug Artane® (trihexyphenidyl)
• Sulfonamide (sulfa)-containing drugs such as Diamox® (acetazolamide) and Bactrim® (trimethoprim-sulfamethoxazole) for infections, and Topamax® (topiramate) for seizures and migraines 

Per the AAO, stop taking these medications and seek immediate treatment if you have eye pain, nausea, vomiting, blurred vision, or see halos or rainbows. If you’re unsure about whether or not a medication is safe, ask your eye care provider or prescribing physician.

*Mukamal, R. (2023, January 19). Common Drugs That Can Worsen Glaucoma. American Academy of Ophthalmology. https://www.aao.org/eye-health/tips-prevention/dangerous-medications-glaucoma-dayquil-bendadryl

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