Vision Science and Eye

Although there is no mention of acute glaucoma on the list of side effects of citalopram in some patient information leaflets, here have been previous published case reports on association of citalopram and other ssr is (selective serotonin reuptake inhibitirs) with acute glaucoma. It is the most severe ssr is related ocular complication. 

Risk factor: race-asianorigin, hyper metropia, family history, female gender, age and shallow anterior chamber. Mechanism of ssri induced acute glaucoma is not clear.

 

An elderly lady with no previous history of glaucoma presented with acute headaches, bilateral ocular pain, photophobia ,worsening vision and fixed dilated pupils. With bilateral raised intra ocular pressures she was initially treated with systemic acetazolamide, ocular hypotensives  then bilateral yag iridotomy. Subsequently  stopped acetazolamide and pilocarpine.she returned with worsening vision and significantly raised iops this time. Her ultrasound b-scans remained unremarkable (though sometimes they can show typical findings).she was discussed with glaucoma specialist (rs) who asked for a full drug history and who stopped the oral citalopram subsequently. Her IPOS normalized improving her symptoms and vision markedly .

 

This patient had been seen a few times earlier , however, a comprehensive drug history was not obtained earlier. A low threshold for drug induced causes of bilateral acute glaucoma, including this as side effect in pils (patient information leaflet) and detailed ophthalmic examination including gonios copy should be carried out even in the presence of patent iridotomies in high risk patients. Warning advice and counselling to the patients should be given.