J Korean Ophthalmol Soc.  2019 Dec;60(12):1356-1362. 10.3341/jkos.2019.60.12.1356.

Report of Bilateral Acute Angle-closure Crisis Induced by Serotonin-norepinephrine Reuptake Inhibitors

• Yoo J
• Jun RM
• Choi KR
• Han KE

• KMID: 2466196
• DOI: http://doi.org/10.3341/jkos.2019.60.12.1356

Abstract

PURPOSE
This study reports a case of bilateral acute angle-closure crisis induced by two kinds of serotonin-norepinephrine reuptake inhibitors (SNRIs), duloxetine and tramadol.
CASE SUMMARY
A 55-year-old female visited our clinic, complaining of bilateral visual impairment, ocular pain, and headache, which began 2 days after taking several drugs including duloxetine and tramadol for the purpose of back pain relief. On the day of the first visit, her uncorrected visual acuity was 0.04 in the right eye and 0.02 in the left eye, and the intraocular pressure (IOP) was 45 mmHg in the right eye and 51 mmHg in the left eye. The anterior chamber was shallow and the anterior chamber-angle was closed in both eyes on gonioscopy. There was mild nuclear sclerosis of both lenses. Assuming drug-induced bilateral acute angle-closure crisis, all medications were discontinued, and IOP-lowering agents were prescribed. The symptoms, visual acuity, and IOP improved; however, both anterior chambers were still shallow and the iridocorneal angle was still closed in both eyes. Laser iridotomy was tried in the right eye but failed because the pupils were not completely constricted, and iris bleeding occurred. Phacoemulsification and posterior chamber lens insertion were conducted in both eyes, and her visual acuity, IOP, anterior chamber depth, and iridocorneal angle have been stable at 9 months since her first visit.
CONCLUSIONS
The combined administration of SNRI may cause bilateral acute angle-closure attacks.

Keyword

Antidepressive agent; Drug-induced angle closure glaucoma; Duloxetine hydrochloride; Serotonin-norepinephrine reuptake inhibitor; Tramadol

MeSH Terms

Anterior Chamber
Back Pain
Duloxetine Hydrochloride
Female
Gonioscopy
Headache
Hemorrhage
Humans
Intraocular Pressure
Iris
Middle Aged
Phacoemulsification
Pupil
Sclerosis
Tramadol
Vision Disorders
Visual Acuity
Duloxetine Hydrochloride
Tramadol

Figure

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  Figure 1 Anterior segment photographs of the first visit. Right eye (A) and left eye (B) showed conjunctival injection and dilated pupils. Right eye (C) and left eye (D) showed shallow anterior chamber and mild nuclear sclerosis with anterior bowing of the iris.

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  Figure 2 Anterior segment optical coherence tomography (AS-OCT) on the 5 days after the first visit. AS-OCT of the right eye (A) and the left eye (B). The scleral spurs are noted (arrows).

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  Figure 3 Images of ultrasound biomicroscopy of the right (A) and the left (B) eye on the 5 days after the first visit. The magnified view of the nasal side of the right eye (C) and the nasal side of the left eye (D). Crystalline lens moved anteriorly and anterior chamber depth and iridocorneal angle were decreased in both eyes. Ciliary effusion is observed in the left eye (yellow asterisk and arrow), while it is not obvious in the right eye.

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