What Medicine Raises Eye Pressure and Increases Glaucoma Risk?

Studies show that in some populations, over 90% of patients with pre-existing open-angle glaucoma experience a significant rise in intraocular pressure (IOP) from certain medications [1.3.4]. Understanding what medicine raises eye pressure is crucial for managing glaucoma risk and protecting your vision.

Quick Summary

Many common medications, including steroids, antidepressants, and allergy drugs, can elevate intraocular pressure, posing a risk for glaucoma. This risk varies depending on the drug type and individual patient factors.

Key Points

• Corticosteroids are a primary cause: Steroids in any form (pills, inhalers, eye drops, creams) are a major cause of increased eye pressure, especially in those with open-angle glaucoma [1.2.6].

• Angle-Closure vs. Open-Angle: Different drugs affect different glaucoma types. Anticholinergics often trigger acute angle-closure, while steroids typically cause a gradual rise in pressure in open-angle glaucoma [1.2.2, 1.2.6].

• Common OTC Drugs Pose a Risk: Many over-the-counter allergy, cold, and sinus medications contain anticholinergic or adrenergic agents that can be dangerous for people with narrow angles [1.2.2, 1.5.1].

• Sulfa Drugs Have a Unique Mechanism: Medications like topiramate cause swelling of internal eye structures, leading to a type of angle-closure glaucoma unrelated to pupil dilation [1.6.7, 1.2.3].

• Communication is Key: Always inform your eye doctor of all medications you are taking, including prescriptions and OTC products, to properly assess your risk [1.2.2].

• Know Your Risk Factors: Individuals with a family history of glaucoma, pre-existing glaucoma, farsightedness, or of Asian descent may be at higher risk for medication-induced glaucoma [1.2.2, 1.2.3].

• Emergency Symptoms: Acute angle-closure glaucoma is an emergency. Seek immediate medical attention for sudden eye pain, blurred vision, halos around lights, and nausea [1.2.2].

The Unseen Pressure: An Introduction to IOP

Intraocular pressure (IOP) is the fluid pressure inside your eye [1.4.1]. It's maintained by a balance between the production and drainage of a fluid called aqueous humor. When this balance is disrupted—either by overproduction of fluid or, more commonly, by blocked drainage—IOP can rise [1.4.2]. Persistently high IOP is a primary risk factor for glaucoma, a condition that damages the optic nerve and can lead to irreversible vision loss [1.2.2]. While many factors contribute to high IOP, a significant and often overlooked cause is the use of certain systemic and topical medications [1.2.3]. This is known as drug-induced glaucoma, which can be categorized as either open-angle or angle-closure glaucoma [1.2.2].

How Can Medications Affect Eye Pressure?

Medications can increase IOP through two primary mechanisms, corresponding to the two main types of glaucoma:

• Open-Angle Glaucoma Mechanism This is the more common form of drug-induced glaucoma. Certain drugs, most notably corticosteroids, can increase the resistance in the eye's drainage system (the trabecular meshwork) [1.4.1, 1.4.6]. They are thought to cause an accumulation of proteins and other materials that clog the drainage channels, leading to a gradual increase in pressure [1.2.5]. This process is often asymptomatic until significant vision loss has occurred [1.2.3].
• Angle-Closure Glaucoma Mechanism This is an ocular emergency. It occurs in individuals with naturally narrow drainage angles [1.2.3]. Certain medications cause the pupil to dilate (mydriasis). This dilation can cause the iris (the colored part of the eye) to bunch up and block the drainage angle completely, leading to a rapid and painful spike in IOP [1.5.1, 1.5.3]. Other drugs, like those containing sulfa, can cause swelling of internal eye structures, pushing the lens and iris forward to physically close the angle [1.2.3, 1.6.7].

Major Drug Categories That Raise Eye Pressure

A wide range of prescription and over-the-counter (OTC) drugs can impact eye pressure. It's crucial to know which type of glaucoma you are at risk for, as some drugs are dangerous for one type but not the other [1.2.6].

Corticosteroids: The Primary Culprits

Steroids are the most well-known class of drugs that can raise IOP and cause open-angle glaucoma [1.2.6]. This risk applies to all forms of administration, including oral pills, inhalers for asthma, nasal sprays, skin creams, and eye drops [1.2.2, 1.2.5]. The potency and duration of steroid use directly correlate with the risk of IOP elevation [1.4.2]. Individuals with pre-existing open-angle glaucoma, a family history of glaucoma, diabetes, or high myopia are at a much higher risk [1.2.3, 1.4.6].

Anticholinergic and Adrenergic Medications

This broad category includes many common drugs that can trigger acute angle-closure glaucoma in susceptible individuals by causing pupil dilation [1.5.4].

• Antihistamines & Decongestants: Many OTC cold, allergy, and sinus medications (e.g., those containing diphenhydramine, ephedrine) have anticholinergic or adrenergic properties [1.2.2, 1.5.1].
• Psychiatric Medications: Certain tricyclic antidepressants (e.g., amitriptyline, imipramine) and selective serotonin reuptake inhibitors (SSRIs) (e.g., paroxetine, citalopram) have weak anticholinergic effects that can pose a risk [1.2.3, 1.7.7].
• Bladder Control & GI Meds: Medications for overactive bladder (e.g., oxybutynin, tolterodine) and gastrointestinal issues (e.g., cimetidine, ranitidine) often have strong anticholinergic effects [1.2.4, 1.5.1].
• Respiratory Inhalers: Inhalers for asthma or COPD containing ipratropium bromide or tiotropium can increase risk [1.5.1].

Sulfa-Based Drugs

Certain medications containing sulfa can induce a specific type of angle-closure glaucoma, not through pupil dilation, but by causing swelling of the ciliary body and other structures in the back of the eye [1.2.3, 1.6.7]. This swelling pushes the lens-iris diaphragm forward, physically blocking the drainage angle. This reaction is idiosyncratic and can occur even in people without pre-existing narrow angles [1.2.3].

• Topiramate: Commonly used for migraines and seizures, this drug is a well-documented cause of bilateral acute angle-closure glaucoma [1.6.1, 1.6.5].
• Other Sulfa Drugs: This class includes certain diuretics (like hydrochlorothiazide) and antibiotics (like sulfamethoxazole) [1.2.4, 1.6.2].

Comparison Table of High-Risk Medications

Medication Class	Example(s)	Associated Glaucoma Type	Mechanism of Action
Corticosteroids	Prednisone, Dexamethasone, Inhaled/Nasal Sprays	Open-Angle	Increases outflow resistance in trabecular meshwork [1.2.5, 1.4.1].
Anticholinergics	Oxybutynin (Bladder), Diphenhydramine (Allergy)	Angle-Closure	Causes pupil dilation (mydriasis), blocking the drainage angle [1.5.1, 1.5.2].
Tricyclic Antidepressants	Amitriptyline, Imipramine	Angle-Closure	Weak anticholinergic effects cause pupil dilation [1.2.3, 1.7.7].
Sulfa-Based Drugs	Topiramate (Migraines), Hydrochlorothiazide (Diuretic)	Angle-Closure	Causes swelling of ciliary body, pushing lens-iris diaphragm forward [1.6.7, 1.5.4].
Adrenergic Agonists	Ephedrine, Phenylephrine (Decongestants)	Angle-Closure	Causes pupil dilation, which can lead to pupillary block [1.2.3, 1.5.4].
SSRIs/SNRIs	Citalopram, Venlafaxine	Angle-Closure (some risk)	Serotonergic and weak anticholinergic effects can cause pupil dilation [1.2.3, 1.7.2].

Who is at Higher Risk?

Certain populations are more susceptible to medication-induced glaucoma:

• Existing Glaucoma: Patients with primary open-angle glaucoma are highly sensitive to steroids [1.3.4].
• Narrow Angles: Individuals with anatomical narrow angles (more common in those of Asian heritage, farsighted individuals, and older adults) are at high risk for drug-induced angle-closure [1.2.2, 1.2.3].
• Family History: A first-degree relative with glaucoma increases risk [1.4.2].
• Other Conditions: People with type 1 diabetes, high myopia, or certain connective tissue diseases are more responsive to steroids [1.2.3].

Proactive Management and Communication

Awareness and communication are key to prevention.

1. Know Your Risk: Get regular eye exams to determine if you have glaucoma or are at risk (e.g., have narrow angles) [1.2.3].
2. Inform Your Doctors: Ensure all your healthcare providers, including your ophthalmologist, are aware of every medication you take—prescription, OTC, and supplements [1.2.2].
3. Monitor Symptoms: For angle-closure, be aware of emergency symptoms like severe eye pain, headache, blurred vision, nausea, and halos around lights [1.2.2]. For open-angle, regular IOP checks by a professional are necessary as it is often asymptomatic [1.2.3].
4. Discuss Alternatives: If you are in a high-risk group, ask your doctor if there are alternative medications that do not carry the same risk to your eye pressure.

Conclusion

While many medications are essential for treating various health conditions, it's vital to be aware of their potential side effects, including the risk of elevating intraocular pressure. Corticosteroids, anticholinergics, and sulfa-based drugs are among the most common culprits. The risk is not the same for everyone and depends heavily on the type of glaucoma and individual anatomical factors. Proactive communication with all members of your healthcare team and regular ophthalmologic monitoring are the most effective strategies to safely use necessary medications while protecting your vision from the silent threat of glaucoma.

For more information, consider visiting the Glaucoma Research Foundation.

Frequently Asked Questions

What common allergy medicine raises eye pressure?

Many common over-the-counter allergy medications, particularly those containing antihistamines with anticholinergic properties like diphenhydramine (Benadryl), can raise eye pressure by dilating the pupil and potentially triggering an acute angle-closure glaucoma attack in susceptible individuals [1.5.1, 1.2.4].

Can antidepressants cause high eye pressure?

Yes, certain antidepressants can increase the risk of high eye pressure. Tricyclic antidepressants (like amitriptyline) and some SSRIs (like citalopram and paroxetine) have weak anticholinergic effects that can dilate the pupil, potentially leading to angle-closure glaucoma in at-risk patients [1.2.3, 1.5.1, 1.7.2].

Do steroids in asthma inhalers affect eye pressure?

Yes, steroids used in asthma inhalers can be absorbed into the body and have been shown to increase intraocular pressure in some individuals, particularly with long-term or high-dose use. This is a risk factor for developing open-angle glaucoma [1.2.5, 1.4.8].

Can blood pressure medication raise eye pressure?

While some blood pressure medications like beta-blockers are used to lower eye pressure, others may have the opposite effect. For example, some studies have linked calcium channel blockers to an increased risk of glaucoma in certain individuals [1.2.4, 1.3.6].

Is drug-induced high eye pressure reversible?

In many cases, elevated eye pressure caused by medication is reversible upon discontinuing the offending drug [1.4.1]. However, if the high pressure is sustained long enough to cause damage to the optic nerve, the resulting vision loss is permanent [1.4.6].

What is the difference between open-angle and angle-closure glaucoma from medications?

Medications like steroids typically cause open-angle glaucoma by clogging the eye's drainage system over time [1.2.5]. Medications like anticholinergics or sulfa drugs can cause angle-closure glaucoma, which is a sudden blockage of the drainage angle, often presenting as a painful ocular emergency [1.2.3, 1.5.4].

Can the migraine medication Topamax (topiramate) affect my eyes?

Yes, Topamax (topiramate) is a sulfa-based drug well-known for causing a rare but serious side effect: bilateral acute angle-closure glaucoma. It causes swelling within the eye that pushes the lens and iris forward, blocking fluid drainage and rapidly increasing eye pressure [1.6.1, 1.6.5].