Single Dose of Pseudoephedrine Induces Simultaneous Bilateral Acute Angle Closure Crisis

Benjamin G Spencer; Jonathan Baskin; Blake F Giarola; Jamie E Craig

doi:10.1159/000503854

Single Dose of Pseudoephedrine Induces Simultaneous Bilateral Acute Angle Closure Crisis

Case Rep Ophthalmol. 2019 Oct 24;10(3):365-368. doi: 10.1159/000503854. eCollection 2019 Sep-Dec.

Authors

Benjamin G Spencer¹, Jonathan Baskin², Blake F Giarola², Jamie E Craig³

Affiliations

¹ Training Medical Officer Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
² Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
³ Ophthalmology Department, Flinders Medical Centre, Adelaide, South Australia, Australia.

Abstract

Simultaneous bilateral acute angle closure crisis (AACC) is a sight-threatening ocular emergency. Many "cold and flu" preparations contain compounds with sympathomimetic or anticholinergic qualities that confer a risk of inducing AACC. We present a review of cold and flu preparation-induced AACC, and present a case of simultaneous bilateral AACC triggered by a single oral dose of pseudoephedrine. The challenges facing the clinician in recognizing simultaneous bilateral AACC in the context of an upper respiratory tract infection are addressed. An awareness of this uncommon clinical entity, its pertinent clinical features, risk factors, and the drug classes that may precipitate an attack is critical for the timely diagnosis and management of this ocular emergency. Notably, clinicians must be aware that even a single dose of an implicated medication may trigger an attack of AACC.

Keywords: Angle closure; Decongestants; Glaucoma; Pseudoephedrine.

Publication types

Case Reports