Glycopyrrolate induced bilateral angle closure glaucoma after cervical spine surgery

Jaroudi, Mahmoud O; Maalouf, Fadi; Farah, Fadi; Mollayess, Georges M El

doi:10.4103/0974-9233.110620

Cited by 15 publications

(6 citation statements)

References 14 publications

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“…Most cases did not present immediately after surgery, but between the first and fifth postoperative day. A similar delay has been noted in patients who develop bilateral acute ACG triggered by general anesthesia [ 9 , 10 ]. The use of potent perioperative analgesics or local anesthesia might attenuate the initial symptoms, leading to a milder presentation in the clinic [ 9 ].…”

Section: Discussionsupporting

confidence: 71%

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature

et al. 2018

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Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.

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Section: Discussionsupporting

confidence: 71%

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature

et al. 2018

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“…There is report of bilateral AACG 12 hours after glycopyrrolate use for NMB reversal after surgery. 17 The patient had undergone cervical spine surgery, requiring him to be in the prone position for 5 hours and 30 minutes. In conjunction with mydriasis and hyperopia, the gravitational effect of the prone position may have contributed to the IOP spike and AACG.…”

Section: Anticholinergic Agentsmentioning

confidence: 99%

Drug-induced Acute Angle-closure Glaucoma: A Review

Yang

Lin

2019

Journal of Current Glaucoma Practice

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Aim: Our goal is to review current literature regarding drug-induced acute angle-closure glaucoma (AACG) and provide ophthalmologists and general practitioners with a thorough understanding of inciting medications and treatment pitfalls to be avoided. Background: Drug-induced AACG is an ophthalmological emergency that ophthalmologists and general practitioners should be familiar with, given its potentially blinding consequences. Common anatomical risk factors for AACG include a shallow anterior chamber depth, short axial length, plateau iris configuration, thick lens, anteriorly positioned lens, and rarely, intraocular tumor. Demographic risk factors include female sex, Asian ethnicity, family history, and advanced age. In patients with predisposing factors, acute angle closure can be triggered by various classes of medications including adrenergic agonists, anticholinergics, cholinergics, sulfonamides, supplements, and serotonergic medications. Physicians prescribing such inciting medications should be aware of their potentially sight-threatening adverse effects and to inform patients of the warning symptoms. Patients typically present with elevated intraocular pressure (IOP), headache, nausea, blurry vision, and halos around lights. Review results: There are two main mechanisms of drug-induced AACG, both with different treatment strategies. The first mechanism of druginduced AACG is pupillary block and iridocorneal angle closure secondary to thickening of iris base with mydriasis. The second mechanism of drug-induced AACG is anterior displacement of the lens-iris diaphragm due to mass effect (e.g., blood, misdirected aqueous humor, and tumors), uveal effusion, or weakened zonules. Conclusion:This paper reviews drug-induced AACG, high-risk anatomical features, underlying mechanisms, inciting medications, and options for treatment and prevention. Clinical significance: With proper understanding of the underlying mechanism of drug-induced AACG, physicians can respond promptly to save their patients' vision by employing the correct treatment strategy.

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“…Tramadol is a commonly prescribed opioid used in severe pain. Tramadol can cause miosis through stimulation of opioid receptors [9] or mydriasis through stimulation of the adrenergic receptors [10]. In fact, it inhibits serotonin and noradrenaline reuptake from the synaptic cleft, and stimulates pre-synaptic release of serotonin [11].…”

Section: Discussionmentioning

confidence: 99%

Bilateral acute angle-closure glaucoma following tramadol subcutaneous administration

et al. 2018

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BackgroundTo report a case of bilateral acute angle closure-glaucoma following the use of subcutaneous Tramadol.Case presentationA 42-year-old healthy man with unremarkable past medical and ocular history, was admitted to the Orthopedic Department for surgical treatment of a bilateral open fracture of the femur following a road accident. Three hoursafterTramadolsubcutaneous injection, the patient complained of a bilateral acute painful visual loss with persistent vomiting. An ocular examination showed bilateral acute angle-closure-glaucoma. The patient was treated with topical anti-glaucoma therapy and intravenous Mannitol 20%.After resolution of ocular hypertension attack, NdYag laser peripheral iridotomy was performed on both eyes. After a follow-up period of 7 days visual acuity improved to 20/20 in both eyes and intraocular pressure returned to normal levels.ConclusionsThis case highlights the risk of developing bilateral acute angle-closure glaucoma after Tramadol administration.KeywordsAngle closure glaucomaMydriasisTramadolAnterior segment OCT

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Glycopyrrolate induced bilateral angle closure glaucoma after cervical spine surgery

Cited by 15 publications

References 14 publications

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature

Drug-induced Acute Angle-closure Glaucoma: A Review

Bilateral acute angle-closure glaucoma following tramadol subcutaneous administration

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