Oral acetazolamide for intraocular pressure lowering: balancing efficacy and safety in ophthalmic practice

ABSTRACT

Introduction: Systemic acetazolamide is an efficacious adjunct to topical therapy to lower intraocular pressure (IOP) in glaucomatous eyes. This article aims to provide a comprehensive review for how best to use the agent in ophthalmic practice.

Areas covered: This article will review the history, mechanism of action, methods of observing efficacy, indications for IOP lowering, side effects, allergy information including discussion of limited cross-reactivity between antimicrobial and non-antimicrobial sulfonamides, formulations, dosing and monitoring of acetazolamide. To select articles for this review, an electronic search was conducted using the PubMed database and cross-referencing was conducted for relevant literature.

Expert opinion: The benefits of oral carbonic anhydrase inhibitor therapy can outweigh the risks in many circumstances. It is important that eye care practitioners work together with a patient’s primary care practitioner to monitor for and mitigate risks. Greater education is needed with regard to the allergy profile of these powerful agents. Though not often a first-line option, oral carbonic anhydrase inhibitors remain pivotal and play in important role in delivery of eye care.

KEYWORDS:

• Acetazolamide
• carbonic anhydrase inhibitor
• glaucoma treatment
• intraocular pressure
• sulfonamide

Article highlights

• Acetazolamide is an efficacious systemic medication used to lower intraocular pressure (IOP) in ophthalmic practice.

• The agent has a broad set of indications including rapid IOP reduction for acute elevations in IOP from angle closure or neovascular glaucoma, long-term therapy for chronic open-angle or closed-angle glaucoma, and peri-operative IOP reduction for intraocular surgery in glaucomatous eyes.

• The notion of allergic cross-reactivity between antimicrobial and non-antimicrobial sulfonamides is not supported.

• The agent has a large side effect profile affecting several organ systems, which may be intolerable for many patients.

• Periodic monitoring with serum chemistries, kidney function and hematologic studies is indicated.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was funded by an unrestricted Departmental grant from Research to Prevent Blindness, New York, NY 10022.