Bilateral simultaneous acute angle closure glaucoma triggered by an over-the-counter cold and influenza medication

Abstract

A woman in her mid-60s who is a high hypermetrope presented with bilateral eye pain and headache approximately 1 hour after taking a single dose of a widely available decongestant containing paracetamol, guaifenesin and phenylephrine hydrochloride for coryzal symptoms. She had previous successful bilateral peripheral iridotomies performed for narrow angles. At presentation, her intraocular pressures (IOPs) were significantly raised at 72 mm Hg and 66 mm Hg in the right and left eye, respectively, with bilateral corneal oedema. Her IOP was normalised with urgent treatment using 500 mg intravenous acetazolamide, pilocarpine 2%, dexamethasone 0.1% and IOP-lowering drops. She was listed for cataract surgery and was advised to avoid the precipitating agent and other over-the-counter decongestants. This is the first reported case of bilateral angle closure triggered by a decongestant with such a combination of ingredients. Clinicians should be aware of this rare side effect for prompt diagnosis and management.

Keywords: Contraindications and precautions; Eye; Glaucoma; Safety; Unwanted effects / adverse reactions.

Figure 1. (A) Anterior segment OCT of the RE looking at the iridocorneal angle with patent peripheral iridotomy following resolution of angle closure. (B) Anterior segment OCT of the RE showing a cross-section of the iris plane following the resolution of angle closure. (C) Anterior segment OCT of the left eye (LE) looking at the iridocorneal angle with patent peripheral iridotomy following resolution of angle closure. (D) Anterior segment OCT of the LE showing a cross-section of the iris plane following the resolution of angle closure. LE, left eye; OCT, optical coherence tomography; RE, right eye.

Figure 2. (A) Humphrey visual perimetry of the right eye showing a relatively full visual field with a superior nasal step. (B) Humphrey’s visual perimetry of the left eye showing a relatively full visual field with a small superior nasal step.