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British Medical Bulletin Advance Access published online on November 17, 2009
British Medical Bulletin, doi:10.1093/bmb/ldp042
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© The Author 2009. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Pharmacological and environmental factors in primary angle-closure glaucoma

Ian Subak-Sharpe{dagger}, Sancy Low{dagger},{ddagger}, Winifred Nolan§ and Paul J. Foster*,{dagger},{ddagger}

{dagger} Moorfields Eye Hospital, London, UK
{ddagger} UCL Institute of Ophthalmology, London, UK
§ Birmingham and Midland Eye Centre, Birmingham, UK

* Correspondence to: P. Foster, Department of Epidemiology and Molecular Genetics, UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK. E-mail: p.foster{at}ucl.ac.uk

Introduction or background: A large number of drug classes have now been reported to provoke angle closure in high-risk individuals. The mechanism of action can be generalized into three main categories: sympathomimetic, parasympatholytic and idiosyndratic reactions.

Sources of data: This review of the ophthalmic literature provides a clinical summary of primary angle-closure glaucoma (PACG) and its management.

Areas of agreement: External stimuli (pharmacological and environmental) may induce acute, and more often, asymptomatic angle closure, which carries a significant risk of glaucoma.

Growing points: Whenever in doubt, patients at risk of PACG who are starting on drug therapy known to provoke angle closure or aggravate the condition should be referred for detailed gonioscopic examination of the anterior chamber by an ophthalmologist.

Areas for developing research: The use of new imaging methods such as anterior segment optical coherence tomography to assess the presence or risk of angle closure is gaining popularity, and may offer a more rapid method of identifying people who are at risk of sight loss from angle-closure glaucoma precipitated by non-ophthalmological medication.

Keywords: angle-closure • glaucoma • drugs • environment

Accepted for publication October 13, 2009.


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