Safety of Psychiatric Medications in Glaucoma. A Review of Current Medical Knowledge

Abstract

Glaucoma is a leading cause of irreversible blindness, and psychiatric patients are at increased risk of ocular adverse effects from pharmacotherapy; this review summarizes the safety of psychiatric medications with respect to glaucoma type, including open-angle and angle-closure forms. A search of PubMed, Scopus, and Web of Science covering studies from 2020 to 2026, including observational studies, meta-analyses, and systematic reviews, assessed associations between psychiatric drugs, glaucoma risk, and intraocular pressure. Selective serotonin reuptake inhibitors demonstrate a favorable profile in open-angle glaucoma, with modest intraocular pressure reduction and decreased risk, whereas benzodiazepines are associated with increased glaucoma risk, particularly in angle-closure glaucoma. Topiramate shows a strong association with acute angle-closure glaucoma, while tricyclic antidepressants, despite anticholinergic effects, do not consistently increase glaucoma risk. Antipsychotics, especially olanzapine, may precipitate acute angle closure, whereas lithium appears neutral or potentially protective. Overall, psychiatric medications exhibit heterogeneous ophthalmic safety, and particular caution is warranted with topiramate and benzodiazepines in patients with narrow angles or angle-closure glaucoma, alongside regular ophthalmologic monitoring.