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

BMJ Case Rep. 2024 Aug 30;17(8):e260950. doi: 10.1136/bcr-2024-260950.

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.

Publication types

  • Case Reports

MeSH terms

  • Acetaminophen* / administration & dosage
  • Acetaminophen* / adverse effects
  • Acetaminophen* / therapeutic use
  • Acetazolamide* / administration & dosage
  • Acetazolamide* / therapeutic use
  • Acute Disease
  • Dexamethasone / administration & dosage
  • Dexamethasone / adverse effects
  • Dexamethasone / therapeutic use
  • Eye Pain / chemically induced
  • Eye Pain / etiology
  • Female
  • Glaucoma, Angle-Closure* / chemically induced
  • Glaucoma, Angle-Closure* / drug therapy
  • Guaifenesin / administration & dosage
  • Guaifenesin / adverse effects
  • Guaifenesin / therapeutic use
  • Humans
  • Intraocular Pressure / drug effects
  • Middle Aged
  • Multi-Ingredient Cold, Flu, and Allergy Medications / adverse effects
  • Nasal Decongestants / administration & dosage
  • Nasal Decongestants / adverse effects
  • Nonprescription Drugs / administration & dosage
  • Nonprescription Drugs / adverse effects
  • Phenylephrine / administration & dosage
  • Phenylephrine / adverse effects
  • Phenylephrine / therapeutic use
  • Pilocarpine / administration & dosage
  • Pilocarpine / adverse effects
  • Pilocarpine / therapeutic use

Substances

  • Acetazolamide
  • Acetaminophen
  • Phenylephrine
  • Nonprescription Drugs
  • Guaifenesin
  • Nasal Decongestants
  • Multi-Ingredient Cold, Flu, and Allergy Medications
  • Pilocarpine
  • Dexamethasone