There are hundreds of pills for which the FDA statements about the drug include a glaucoma caution, that is, they say that it may be dangerous for those with “glaucoma” to take them. Among these are the many medicines used for anxiety and psychological disorders, things like the serotonin reuptake inhibitors, the first of which was Prozac (fluoxetine). There were reported examples of angle closure glaucoma that happened in those taking this pill. The same could occur with all the frequently used drugs that help with urinary incontinence and with some of the upper respiratory cold pills. For all of these, the risk is that the pupil might be dilated, and angle closure might result. But, for all those with open angles, these medications are perfectly fine. And, they’re fine for any angle closure person who has already had an iridotomy (see section Acute angle closure crisis).

So, what should you and your medical doctor do when you want to use a medication, but it has a glaucoma caution on the label? An example is Topamax (Topiramate), a headache medicine that causes an unusual form of angle closure (not related to dilating the pupil). Call your ophthalmologist. In nearly every case, it will be fine to start the pill. The best approach is often to start it and have an eye exam in the next month to check on potential bad effects. If you know you have open angle glaucoma, you can take most medications that have a warning about glaucoma, but you need to be monitored if you start taking some of them.

Most worrisome for glaucoma patients or those at risk for glaucoma, are medications that deliver corticosteroid (“steroid”) to your body. We use steroids as ways to treat a huge number of disorders, including arthritis, asthma, sinus trouble, and more serious general body disorders. Cortisone (prednisone) in any formulation at full dosage can, in fact, cause eye troubles, but if they help your general condition, we can manage the effects. The eye issue closest to this discussion is an increase in eye pressure caused by steroids. This occurs in the more sensitive person even from nasal sprays and inhalers that have steroids. It can possibly occur from injections into joints, pills, and particularly injections of steroid into the eye for various diseases will often increase eye pressure. The right answer is always to get the doctors talking to each other and watch things carefully.

There are more and more suggestions that how we control the blood pressure of persons can be relevant to open angle glaucoma. High blood pressure can kill you, so get it treated. But, we run across persons taking three or even four pill types for hypertension. One has to wonder if this is the same issue as we find with glaucoma drugs. If you forgot to take your pills when you saw the doctor, he/she might have added another one. If the same thing happened again, pretty soon you were being prescribed three or four of them. This happened to an older family relative. She was found in her bathroom in the middle of the night, having fallen and hit her head on the sink. Turns out she was taking several pills for blood pressure (and one for sleep) and had just re-filled them after not having them all recently. Suddenly, a huge drop in blood pressure happened from taking everything (and the sleeping pill) and she wound up in the hospital. Our point is that we should be using the right amount of medicine and taking it regularly, so that the doctor can tell how to give neither too much nor too little. It’s worse for a glaucoma patient to have low blood pressure than to have high blood pressure. Lesson one, take your pills. Lesson two, don’t get put on four medications when one or two will do the job if only you were taking them properly.