A 46-year-old man with sickle cell disease presents with raised intraocular pressure of 30 mmHg in both eyes from chronic steroid use. Which antiglaucoma medication is specifically avoided in him?
- A Topical latanoprost
- B Oral acetazolamide ✓
- C Topical timolol
- D Oral methazolamide
Correct answer: B. Oral acetazolamide
Explanation
Systemic carbonic anhydrase inhibitors such as acetazolamide induce metabolic acidosis. Acidosis shifts the oxygen dissociation curve, promotes haemoglobin S polymerisation, and can trigger sickling crises, particularly in renal medullary and choroidal vessels where sludging threatens optic nerve perfusion. Topical agents are preferred in these patients. Methazolamide produces less systemic acidosis than acetazolamide but is still used cautiously, whereas latanoprost and timolol carry no sickling risk.
Reference: American Academy of Ophthalmology, BCSC Section 10: Glaucoma, 2023 ed.
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Written and medically reviewed by the StethoPrep medical team.