Reactions 491 - 5 Mar 1994

SImipramine

Acute angle closure glaucoma: 4 case reportsAcute angle closure glaucoma was triggered in 3 women and

1 man, aged 56–63 years, 24 hours–5 weeks after they beganimipramine therapy.

Three of the patients were receiving imipramine fordepression [dosage not stated]. The fourth patient had adiagnosis of intermittent angle closure glaucoma and had beenscheduled for laser iridotomy. She was given imipramine by afriend the day before the procedure and took two 10mgtablets, one in the evening and one the following morning.

All patients were known to have narrow iridocorneal anglesand 2 were using pilocarpine eye drops. One patient hadalready undergone surgical iridectomy for acute angle closurein the left eye.

The patients experienced pain in their right eyes and 2 alsocomplained of blurring of vision. Intraocular pressures in theright eyes were 38–55mm Hg, but only 12–15mm Hg in theleft.

On examination, all patients were found to have angleclosure of the right eye and required medical treatment toterminate the attack and laser iridotomy to normalise theintraocular pressure. One patient developed iris atrophy andcataract as a result of the acute attack.

Two of the patients with depression were recommenced onimipramine after successful laser iridotomy without anyfurther ocular adverse events.

Author comment: ‘Our four patients all suffered acute angleclosure glaucoma after taking routinely prescribed doses ofimipramine . . . [Tricyclic antidepressants] are contraindicatedin patients with occludable angles . . . Patients with knownnarrow angles for whom treatment with tricyclicantidepressants is indicated should be monitored by anophthalmologist.’Ritch R, et al. Oral imipramine and acute angle closure glaucoma. Archives ofOphthalmology 112: 67-68, Jan 1994 - USA 800252163

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Reactions 5 Mar 1994 No. 4910114-9954/10/0491-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved