Presumed Furosemide-Associated Bilateral Angle-Closure Glaucoma
Purpose
To report a case of presumed furosemide-associated bilateral angle closure glaucoma and myopic shift in a pregnant patient who presented in the early second trimester. Furosemide has not yet been described to cause this reaction. We also highlight the use of oral steroids as a therapeutic measure when conventional medical therapy is contraindicated.
Methods
Case report.
Results
A 21 year old African American female in her 17th week of pregnancy presented with bilateral acute angle closure glaucoma after being started on furosemide in her first trimester. Intraocular pressures were elevated (low 40's mmHg OU) and anterior chambers were shallow (grade 1 Schaffer angles) on gonioscopy. Medical history included two prior failed pregnancies complicated by fluid overload. She was started on 60 mg of prednisone daily along with topical brimonidine in both eyes twice daily. After three days, her intraocular pressures normalized. At one week, her anterior chambers deepened and gonioscopy confirmed widened angles. Oral prednisone was titrated down for the remainder of her uneventful pregnancy. On follow-up one month postpartum, intraocular pressures and best-corrected visual acuities reached preterm baseline values.
Conclusion
Our case highlights a well described idiosyncratic reaction that can follow exposure to certain sulphonamide-containing drugs. Therapeutically, we opted for a trial of oral prednisone which was rapidly effective. We elected not to withdraw furosemide due to the serious health consequences of fluid overload in the patient’s previous pregnancy. We propose that in similar clinical settings, oral prednisone started at a dose of 1 mg/kg with clinically guided taper may be an effective therapeutic option.