Medications to Avoid with Glaucoma

Anticholinergic drugs block a chemical messenger in the nervous system called acetylcholine. Doctors prescribe them for stomach cramps, motion sickness, Parkinson disease, and many other conditions. These medications can dilate the pupil and significantly increase the risk of angle closure in people with narrow angles.

• Motion-sickness pills often contain anticholinergic ingredients
• Medications for nausea, tremors, and muscle stiffness may fall into this category
• Always check with us before starting any new anticholinergic drug

Steroids reduce inflammation but can raise eye pressure in many people, including those with open-angle glaucoma. This risk applies to steroid pills, injections, inhalers, nasal sprays, skin creams used near the eyes, and steroid eye drops. The risk increases with higher-potency steroids and longer duration of use.

If you must take steroids for asthma, arthritis, allergies, or another condition, we monitor your eye pressure more frequently and may adjust your glaucoma treatment to counteract the effect.

• We often check pressure within two to four weeks after a steroid is started
• Tell us if you or a close family member has had a strong pressure response to steroids in the past

Some antidepressants and anti-anxiety medications have anticholinergic effects that can widen the pupil. Tricyclic antidepressants carry the greatest risk for angle closure. Newer antidepressants, including SSRIs and SNRIs, are less anticholinergic but can still pose a risk in eyes with narrow angles. We review each option based on your specific anatomy.

Your mental health matters as much as your eye health. We work alongside your psychiatrist or primary care provider to identify a medication that addresses your mood safely.

• Higher risk: amitriptyline, nortriptyline, imipramine
• Use with caution in narrow angles: SSRIs and SNRIs
• Discuss bupropion and MAO inhibitors with us before starting

Many over-the-counter cold and allergy products contain decongestants or antihistamines that can dilate the pupil or raise eye pressure. Multi-symptom formulas often combine several risky ingredients, and the label does not always make it easy to identify which ones are present.

• Higher-risk decongestants: pseudoephedrine and phenylephrine
• Higher-risk first-generation antihistamines: diphenhydramine, doxylamine, chlorpheniramine, promethazine
• Redness-relief eye drops containing tetrahydrozoline or oxymetazoline can pose risks for narrow angles
• Generally safer allergy options for many patients: loratadine, cetirizine, or fexofenadine
• Saline nasal sprays or rinses are a good first option for congestion
• Intranasal steroid sprays rarely raise pressure, but long-term use should be monitored

Drugs that treat urinary urgency and frequency often have strong anticholinergic properties. They relax the bladder muscle by blocking the same chemical signals that also control the pupil. People with narrow angles or primary angle-closure glaucoma should use these drugs only under close supervision.

Your urologist may be able to offer alternatives with fewer eye-related side effects.

• Higher-risk options: oxybutynin, tolterodine, solifenacin, darifenacin
• Potential alternatives: beta-3 agonists such as mirabegron or vibegron, bladder training, pelvic floor therapy

A wide range of other drugs can affect eye pressure or glaucoma, including medications for nausea, seizures, and certain heart conditions. Some weight-loss drugs also carry warnings for people with glaucoma. Any time a new medication is prescribed, mention your glaucoma diagnosis and ask the prescribing provider whether it is safe for your specific type. We are always available to consult with your other care providers.

Open-angle and angle-closure glaucoma respond very differently to the same medications. Pupil-dilating drugs pose far less risk when the drainage angles are open and wide. People with narrow angles or a history of angle closure must avoid those drugs much more strictly. We measure your drainage angles using a technique called gonioscopy and classify your glaucoma type so our guidance is accurate for your specific situation.

If your angles are narrow or you are considered an angle-closure suspect, we may recommend a laser peripheral iridotomy before you begin any medications that can dilate the pupil. This procedure reduces the risk of pupillary-block angle closure, though it does not prevent topiramate-related angle closure or risks associated with plateau iris.

We measure your eye pressure at every visit using an instrument called a tonometer. When you begin a medication that carries some risk, we may schedule additional appointments to check pressure more frequently. Tracking your pressure over time allows us to detect even small increases before they cause harm.

• Baseline readings establish your normal pressure range
• Follow-up exams reveal any upward trend early
• We also examine the optic nerve for signs of new damage
• Visual field tests confirm whether your side vision remains stable

Sometimes you need a medication for a serious condition even though it carries some eye-related risk. We help you and your other providers weigh the benefits of treatment against the potential for increased pressure. In many cases, we can adjust your glaucoma therapy to offset the risk, or we can monitor you more closely while you take the medication. You should never stop a prescribed medication without first consulting the doctor who prescribed it.

We communicate directly with your primary care physician, specialists, and pharmacists whenever a new medication could affect your glaucoma. Sharing information about your eye condition and current treatments helps every member of your care team make better decisions. Always give your other providers our contact information and encourage them to reach out with any questions about eye safety.