Angle-closure glaucoma pupil dilation

IPRATROPIUM BRONCHODILATORS -SALBUTAMOL A few reports of acute angle closure glaucoma when nebulized ipratropium and salbutamol were coadministered Ipratropium dilates the pupil, which i drainage of aqueous humour, while salbutamol t production of aqueous humour Warn patients to prevent the solution to mist or enter the eye. Extreme caution in co-administering these bronchodilators by the nebulized route in patients with a history of acute closed-angle glaucoma... 

The doctor s examination has revealed that there is a possibility of elevating the pressure inside your eye when dilation is performed. The medical term for this eventuality is "angle closure glaucoma". Because of this possibility, once your pupil is dilated and the interior of the eye has been examined, the pressure will be checked again. Should it become elevated, it will be necessary to lower the pressure by administering eyedrops and oral medication. Afterwards, it may be necessary to refer you to an eye surgeon for treatment with a laser to prevent further occurrences of this kind. 

Figure 20-12 Plateau iris. Dilation of the pupil causes the iris to obstruct aqueous outflow, thus causing acute angle-closure glaucoma.

As of 17 August 2001 there were 23 reported cases (22 adults and 1 child) out of 825 000 patients. Symptoms typically occur within the first month of therapy, and the patients report acutely reduced visual acuity and/or ocular pain. There is myopia, redness, swelling of the anterior chamber, and raised ocular pressure, with or without pupil dilatation. Supraciliary effusion can displace the lens and iris anteriorly, secondarily causing angle-closure glaucoma. The symptoms are reversible if topiramate is withdrawn. Acute myopia has been described as a rare idiosyncratic reaction to other sulfonamides. It has been postulated that the pathogenic mechanism is related to partial inhibition of carbonic anhydrase and to ciliary body swelling. 

Dilation of the pupil in the preexisting narrow anterior chamber may cause the iris to block aqueous humor outflow via the anterior chamber. This leads to an abrupt increase in lOP, resulting in an acute attack of angle-closure glaucoma. Signs and symptoms include blurred vision (often with colored halos around the light), severe ocular pain, red conjunctiva, diaphoresis, and nausea/vomiting. The cornea may appear cloudy due to edema. Upon presentation, the lOP is frequently above 50 mm Hg. 

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