Reactions 1174 - 20 Oct 2007

SCitalopram/imipramine

Bilateral symptomatic angle closure: case reportA 55-year-old woman with depression developed bilateral

symptomatic angle closure during treatment with citalopram,and a relapse occurred after her previous imipramine therapywas restarted.

The woman initially received imipramine [dosage andduration of treatment not stated], which was then changed tocitalopram 20mg/day in July 2005. She presented with asudden onset of blurred vision bilaterally in December 2005.Her symptoms persisted for a few hours, and then her visionnormalised, but left her with a mild headache. She worehypermetropic glasses (+3.75 dioptre OD, +4.75 dioptreOS). Examination revealed visual acuities of 6/6 with clearcorneas, but intraocular pressures (IOPs) were 56mm Hg inher right eye and 34mm Hg in her left eye. Her pupils weremid-dilated, with a sluggish reaction to light. Gonioscopyshowed appositional angle closure of >270° on the right andapproximately 200° on the left.

Bilateral symptomatic angle closure was diagnosed and thewoman received acetazolamide, pilocarpine, apraclonidineand levobunolol. Her left eye IOP decreased to 18mm Hg, butargon laser iridoplasty was required in her right eye. She thenreceived bilateral Nd:YAG laser iridotomies. On discharge, herIOP was 16mm Hg and 14mm Hg in her right and left eyes,respectively, with patent iridotomies. She was prescribedpilocarpine and prednisolone and citalopram wasdiscontinued.

Imipramine was restarted at a dosage of 25 mg/day onMay 9 2006 and, 2 days later, she was found to have>270° appositional angle closure despite patent iridotomies;her IOP was 28mm Hg and 23mm Hg in her right and left eyes,respectively. She received pilocarpine and continued receivingimipramine until July 7 2006, at which time her treatment waschanged to mirtazepam [sic]. Her IOPs and anglessubsequently normalised.

Author comment: "We propose a slow (possible partiallyserotonergic) effect on the iris and/or ciliary body attributableto citalopram given the delay in the onset of symptoms, anda more direct antimuscarinic effect of imipramine, which hadan almost immediate effect."Massaoutis P, et al. Bilateral symptomatic angle closure associated with a regulardose of citalopram, and SSRI antidepressant. British Journal of Ophthalmology 91:1086-1087, No. 8, Aug 2007 - United Kingdom 801091815

1

Reactions 20 Oct 2007 No. 11740114-9954/10/1174-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved