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Oral Imipramine and Acute Angle-Closure Glaucoma-Reply FREE

Robert Ritch, MD; Theodore Krupin, MD; Charles Henry, MD; Fred Kurata, MD
Arch Ophthalmol. 1995;113(6):699-699. doi:10.1001/archopht.1995.01100060020010
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In reply  We thank Drs Epstein, Goldbloom, Kramer, and Reines for their interest in our report. We certainly agree that in highrisk patients, psychoactive agents with little or no cholinergic activity should be considered, and we did not mean to imply that the terms "psychoactive" and "anticholinergic" should be equated. However, a high-risk patient is one with an occludable angle, and such a situation is an indication for laser iridotomy.1,2 After iridotomy, any of these drugs can be given safely (except perhaps in the rare case of complete plateau iris syndrome). Therefore, one need not be concerned about what drugs to prescribe and what drugs not to prescribe. The important point for the psychiatric community is to be able to recognize the high-risk cases, most of which are found in patients with hyperopia.It should be noted that both fluoxetine hydrochloride and mianserin hydrochloride, a diperazinoazepine antidepressant that has

REFERENCES

Rivera AH, Brown RH, Anderson DR.  Laser iridotomy vs surgical iridectomy: have the indications changed? Arch Ophthalmol . 1985;;103:1350-1354.
Ritch R.  The treatment of angle-closure glaucoma . Ann Ophthalmol . 1979;;11:1373-1375.
Ahmad S.  Fluoxetine and glaucoma . Ann Pharmacother . 1991;;25:436.
Kinek M.  Glaucoma following the antidepressant mianserin . Harefuah . 1990;;1990:699-700.
Davidson SJ.  Reports of ocular adverse reactions . Trans Ophthalmol Soc UK . 1974;;43:455-461.
Mandelkorn RM, Zimmerman TJ.  Effects of nonsteroidal drugs on glaucoma . In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas . St Louis, Mo: Mosby-Year Book; 1989;;2:1169-1186.
Lowe RF, Ritch R.  Angle-closure glaucoma: clinical types . In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas . St Louis, Mo: Mosby-Year Book; 1989;;2:839-853.
Cross M, Croll LJ.  Emotional glaucoma . Am J Ophthalmol . 1960;;49:297-305.
Inman WS.  Emotion and acute glaucoma . Lancet . 1929;;2:1188-1189.
Physician's Desk Reference . 47th ed. Oradell, NJ: Medical Economics Co; 1993;.

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Rivera AH, Brown RH, Anderson DR.  Laser iridotomy vs surgical iridectomy: have the indications changed? Arch Ophthalmol . 1985;;103:1350-1354.
Ritch R.  The treatment of angle-closure glaucoma . Ann Ophthalmol . 1979;;11:1373-1375.
Ahmad S.  Fluoxetine and glaucoma . Ann Pharmacother . 1991;;25:436.
Kinek M.  Glaucoma following the antidepressant mianserin . Harefuah . 1990;;1990:699-700.
Davidson SJ.  Reports of ocular adverse reactions . Trans Ophthalmol Soc UK . 1974;;43:455-461.
Mandelkorn RM, Zimmerman TJ.  Effects of nonsteroidal drugs on glaucoma . In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas . St Louis, Mo: Mosby-Year Book; 1989;;2:1169-1186.
Lowe RF, Ritch R.  Angle-closure glaucoma: clinical types . In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas . St Louis, Mo: Mosby-Year Book; 1989;;2:839-853.
Cross M, Croll LJ.  Emotional glaucoma . Am J Ophthalmol . 1960;;49:297-305.
Inman WS.  Emotion and acute glaucoma . Lancet . 1929;;2:1188-1189.
Physician's Desk Reference . 47th ed. Oradell, NJ: Medical Economics Co; 1993;.

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