The issue of glaucoma and the mydriatic effects of SSRIs (Selective Serotonin Reuptake Inhibitors)?
I would like to ask about glaucoma, specifically angle-closure glaucoma.
A few years ago, I was prescribed SSRI antidepressants by a psychiatrist and took them continuously for several years, but I stopped about a year and a half ago.
Approximately three to four years ago, I was monitored for an enlarged optic disc.
Recently, I discovered that my intraocular pressure is elevated, and my sleep has also been somewhat affected.
Therefore, my psychiatrist suggested that if I want to address my insomnia, I may need to resume taking SSRIs for a period of time.
However, I found online that these types of medications can have an effect on pupil size (narrow-angle glaucoma – SSRIs may cause pupil dilation.
This dilation effect could narrow the angle of the eye, leading to increased intraocular pressure and narrow-angle glaucoma.
Therefore, patients with narrow-angle glaucoma or a history of glaucoma should use these medications with caution).
Although I have myopia and my doctor has indicated that I cannot have narrow-angle glaucoma, I am concerned that these medications may cause pupil dilation, which could increase the production of aqueous humor.
If these medications are taken at night, and if aqueous humor secretion is lower at night, could long-term use lead to issues with aqueous humor outflow and potentially trigger glaucoma?
I would like to ask the following questions:
1.
If these medications are taken long-term and cause pupil dilation, is there a concern for developing glaucoma?
2.
For individuals with glaucoma, will taking these medications accelerate the progression of the condition? Or is this concern only relevant for those with narrow-angle glaucoma, while those with open-angle glaucoma do not need to worry?
3.
Can early-stage glaucoma, regardless of type, be assessed using OCT (Optical Coherence Tomography) to determine results before any changes in visual fields occur?
Alan, 20~29 year old female. Ask Date: 2014/03/14
Dr. Wang Yuwei reply Ophthalmology
Indeed, as you mentioned, patients with open-angle glaucoma can take these medications with relatively few concerns, as long as they are regularly monitored by an ophthalmologist.
Currently, Optical Coherence Tomography (OCT) can indeed detect early damage to the optic nerve or nerve fibers, providing valuable information for diagnosis and treatment.
Reply Date: 2014/03/14
More Info
When considering the use of selective serotonin reuptake inhibitors (SSRIs) in patients with glaucoma, it is essential to understand the potential risks and benefits associated with these medications. SSRIs, such as paroxetine, are commonly prescribed for depression and anxiety disorders, but they can have implications for patients with a history of glaucoma, particularly those with narrow-angle glaucoma.
1. Impact of SSRIs on Pupil Size and Glaucoma Risk: SSRIs can cause mydriasis, or pupil dilation, which may lead to an increased risk of angle closure in patients with narrow-angle glaucoma. This is because the dilation can narrow the angle between the iris and cornea, potentially obstructing the outflow of aqueous humor and increasing intraocular pressure (IOP). For patients with open-angle glaucoma, the risk is generally lower, as the mechanism of fluid drainage is different. However, it is still crucial for patients with any form of glaucoma to be monitored closely when starting SSRIs, especially if they have a history of elevated IOP.
2. Worsening of Glaucoma Symptoms: For patients with existing glaucoma, the introduction of SSRIs may exacerbate their condition, particularly if they have narrow-angle glaucoma. Open-angle glaucoma patients may not experience a significant worsening of their condition, but they should still be vigilant. Regular eye examinations and monitoring of IOP are essential to ensure that any changes in eye pressure are detected early. If a patient notices any changes in vision or experiences symptoms such as headaches or eye pain, they should consult their ophthalmologist immediately.
3. Use of OCT for Early Detection: Optical coherence tomography (OCT) is a valuable tool for detecting early changes in the optic nerve and retinal nerve fiber layer, which can indicate glaucoma progression before visual field changes occur. This technology allows for the monitoring of patients with glaucoma and can help in assessing the impact of medications like SSRIs on their condition. Regular OCT scans can provide critical information about the health of the optic nerve and help guide treatment decisions.
In summary, while SSRIs can be effective for treating anxiety and depression, their use in patients with glaucoma requires careful consideration. Patients should engage in open discussions with their healthcare providers about the risks and benefits of SSRIs, particularly in relation to their eye health. Regular monitoring of IOP and visual function is crucial, and patients should be proactive in reporting any changes in their symptoms. Ultimately, the decision to use SSRIs should be made collaboratively between the patient, psychiatrist, and ophthalmologist, ensuring that all aspects of the patient's health are taken into account.
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