What Drugs Cause High Eye Pressure?

October 5, 2025 •

4 min read

In the general population, up to 8% of people may experience a significant rise in eye pressure from steroid use [1.4.3]. This is just one example of how common medications pose a risk. Understanding what drugs cause high eye pressure is crucial for preventing serious complications like glaucoma.

Quick Summary

Many common prescription and over-the-counter drugs can elevate intraocular pressure, increasing glaucoma risk. Key culprits include corticosteroids, anticholinergics, and certain antidepressants and decongestants.

Key Points

Corticosteroids are a Major Cause: All forms of steroids (oral, topical, inhaled) can raise eye pressure by reducing fluid outflow, primarily risking open-angle glaucoma [1.2.3, 1.4.2].
Anticholinergics Trigger Angle Closure: Common drugs like antihistamines, some antidepressants, and incontinence medications can dilate the pupil, blocking the eye's drainage angle in susceptible individuals [1.5.5, 1.8.4].
Sulfa-Drugs Cause Swelling: Medications like topiramate and certain diuretics can cause internal eye structures to swell, pushing the lens forward and causing acute angle-closure glaucoma [1.8.1, 1.9.2].
OTC Medications Carry Risks: Over-the-counter cold and allergy remedies often contain decongestants and antihistamines that can be dangerous for people with narrow angles [1.6.5].
Consult Your Doctors: Never stop a prescribed medication without medical advice. Always inform your eye doctor of all medications you are taking [1.5.5].
Know Emergency Symptoms: Severe eye pain, blurred vision, and nausea after starting a new medication can signal an acute pressure spike and require immediate medical attention [1.2.3].
Risk Factors Matter: Individuals with existing glaucoma, a family history of it, older age, or of Asian descent are at higher risk for drug-induced glaucoma [1.3.5, 1.8.4].

Understanding High Eye Pressure and Medication Risks

High intraocular pressure (IOP), or ocular hypertension, occurs when the pressure inside the eye is higher than normal. This condition is a primary risk factor for glaucoma, a disease that damages the optic nerve and can lead to irreversible vision loss [1.4.3]. While many factors contribute to high IOP, a significant and often overlooked cause is the use of certain systemic and topical medications. Drug-induced glaucoma can manifest through two main mechanisms: open-angle glaucoma, where fluid drainage is slowly impaired, and angle-closure glaucoma, where the drainage angle is physically blocked [1.8.1]. Some medications increase the resistance in the eye's drainage system (the trabecular meshwork), while others can cause anatomical changes, like pupil dilation, that precipitate a sudden blockage [1.4.2, 1.8.4]. Awareness of which drugs carry these risks is essential for both patients and healthcare providers to mitigate potential harm.

Key Drug Classes That Elevate Intraocular Pressure

A wide array of commonly prescribed and over-the-counter medications can lead to an increase in IOP. It is vital to recognize these drug classes and understand their mechanisms.

Corticosteroids

Corticosteroids are powerful anti-inflammatory drugs and are one of the most well-known causes of elevated IOP [1.2.3, 1.3.4]. This effect, known as a "steroid response," can occur with all forms of administration, including oral, topical eye drops, inhaled, nasal, and even skin creams [1.2.3, 1.4.2]. Steroids are believed to increase IOP by increasing the resistance to aqueous humor outflow from the trabecular meshwork [1.4.2]. The risk and severity depend on the steroid's potency, the dose, and the duration of treatment [1.4.2]. Individuals with pre-existing open-angle glaucoma or a family history are at a much higher risk, with over 90% of these patients experiencing a pressure spike [1.3.5].

Medications with Anticholinergic and Adrenergic Effects

This broad category includes many common drugs that can trigger acute angle-closure glaucoma, especially in individuals with anatomically narrow angles [1.2.1, 1.6.1]. These drugs cause the pupil to dilate (mydriasis), which can cause the iris to bunch up and block the eye's drainage angle, leading to a rapid and painful increase in pressure [1.5.3, 1.8.4].

Antihistamines and Decongestants: Many OTC cold, allergy, and sinus medications contain antihistamines (like diphenhydramine) and decongestants (like pseudoephedrine), which have these dilating effects [1.6.5, 1.5.5].
Antidepressants: Tricyclic antidepressants (TCAs) and, to a lesser extent, Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) possess anticholinergic properties that may increase the risk of angle closure [1.2.1, 1.7.3, 1.7.5].
Incontinence and GI Medications: Drugs used for overactive bladder (e.g., oxybutynin) and gastrointestinal issues (e.g., cimetidine) can also have anticholinergic effects [1.5.1, 1.2.3].
Respiratory Inhalers: Some inhalers for COPD and asthma, particularly those containing ipratropium or albuterol, can pose a risk if the medication comes into contact with the eyes [1.5.1, 1.8.4].

Sulfa-Based Drugs

Certain medications containing sulfonamides can induce a rare but serious form of bilateral acute angle-closure glaucoma [1.8.1]. Unlike anticholinergics, these drugs do not primarily act by dilating the pupil. Instead, they are thought to cause swelling of the ciliary body and choroid (ciliochoroidal effusion), which pushes the lens-iris diaphragm forward, physically closing the drainage angle [1.8.3, 1.10.2]. This can occur even in patients without pre-existing narrow angles [1.8.1]. Symptoms often appear quickly, within the first few weeks of starting the drug [1.2.3].

Topiramate (Topamax): Used for migraines and seizures, this is a well-documented cause [1.10.1, 1.2.1]. It can also induce a significant myopic (nearsighted) shift in vision [1.10.3].
Other Sulfa Drugs: This class also includes certain diuretics (like hydrochlorothiazide), antibiotics (like trimethoprim-sulfamethoxazole), and acetazolamide itself, which is ironically also used to lower eye pressure [1.9.2, 1.9.4].

Comparison Table of High-Risk Medications


Drug Class	Common Examples	Primary Mechanism of IOP Increase	At-Risk Glaucoma Type
Corticosteroids	Prednisone, Dexamethasone, Hydrocortisone	Reduced aqueous outflow [1.4.2]	Open-Angle
Anticholinergics	Diphenhydramine (Benadryl), Oxybutynin, Amitriptyline	Pupil dilation causing drainage angle blockage [1.8.4]	Angle-Closure
Adrenergics	Pseudoephedrine, Phenylephrine, Albuterol	Pupil dilation causing drainage angle blockage [1.2.1]	Angle-Closure
Sulfa-Based Drugs	Topiramate (Topamax), Hydrochlorothiazide	Ciliochoroidal effusion pushing lens forward [1.8.4]	Angle-Closure
Antidepressants	SSRIs (Sertraline), SNRIs (Venlafaxine), TCAs	Pupil dilation; some may also cause effusions [1.7.2, 1.8.2]	Primarily Angle-Closure
Anticoagulants	Warfarin, Heparin	Rarely, internal eye bleeding causing a blockage [1.2.1]	Angle-Closure

Managing the Risk and Seeking Help

The most critical step in managing drug-induced high eye pressure is communication between the patient and their healthcare team, including their primary physician and eye doctor [1.5.5]. Patients with risk factors—such as a personal or family history of glaucoma, older age, high myopia, or Asian descent—should be particularly cautious [1.3.5, 1.4.3]. Before starting a new high-risk medication, a baseline eye exam is recommended [1.4.1].

Symptoms of a sudden, severe increase in eye pressure (acute angle-closure) are a medical emergency and include [1.2.3]:

Severe eye pain
Blurred vision or seeing halos around lights
Headache
Nausea and vomiting

If you take any of these medications and experience these symptoms, seek immediate medical attention [1.10.1]. Never stop taking a prescribed medication without first consulting your doctor. Often, the management involves discontinuing the offending drug, if possible, and using eye drops or other treatments to lower the pressure [1.4.2, 1.8.4]. For many, the pressure returns to normal after the medication is stopped [1.4.3].

Conclusion

Many widely used medications carry a risk of increasing intraocular pressure, potentially leading to drug-induced glaucoma and vision loss. Corticosteroids, drugs with anticholinergic effects like common cold remedies and certain antidepressants, and sulfa-based drugs are among the primary culprits [1.3.4]. Each acts through different mechanisms, either by impairing fluid drainage slowly or by causing a sudden, painful blockage. Patient awareness and proactive communication with both prescribing physicians and ophthalmologists are paramount. Regular eye exams, especially for those with existing risk factors for glaucoma, can help detect pressure changes early and prevent permanent damage to your vision [1.4.1].

For more information, consult authoritative sources such as the Glaucoma Research Foundation [1.4.3].

Frequently Asked Questions

Yes, many over-the-counter allergy pills contain antihistamines, which have anticholinergic properties. These can cause the pupil to dilate and may trigger an acute angle-closure glaucoma attack in people with narrow drainage angles [1.5.5, 1.6.1].

Not everyone experiences a rise in eye pressure from steroids, but it is a common side effect. The risk is higher for those with open-angle glaucoma, a family history of glaucoma, or diabetes [1.4.2, 1.4.3]. The potency and duration of steroid use also play a significant role [1.4.2].

Tricyclic antidepressants (TCAs) and, to a lesser extent, SSRIs and SNRIs can increase the risk of acute angle-closure glaucoma due to their anticholinergic effects that cause pupil dilation [1.2.1, 1.7.3, 1.7.5]. Some studies show a higher risk within the first week of starting an SSRI [1.7.1].

If you have open-angle glaucoma (the most common type), most decongestants are generally considered safe. However, if you have narrow-angle glaucoma, you should avoid medications with decongestants (like pseudoephedrine) and antihistamines, as they can trigger a dangerous pressure spike [1.6.1, 1.6.3].

Topiramate, a sulfa-based drug, can cause an idiosyncratic reaction leading to swelling of the ciliary body and choroid. This pushes the lens forward, blocking the eye's drainage angle and causing acute angle-closure glaucoma, often accompanied by a sudden shift toward nearsightedness [1.8.4, 1.10.2].

In most cases, elevated eye pressure caused by a medication is reversible and returns to normal within a few weeks of discontinuing the drug [1.4.3]. However, if the high pressure is not detected and treated, it can cause permanent optic nerve damage and vision loss [1.4.1].

Symptoms of acute angle-closure glaucoma are severe and sudden. They include intense eye pain, blurred vision, seeing halos around lights, a red eye, headache, and nausea or vomiting [1.2.3]. This is a medical emergency requiring immediate attention.