A 19-year-old man with sickle cell trait sustains a traumatic hyphema filling 40% of the anterior chamber with IOP of 32 mmHg. Which class of antiglaucoma medication should be AVOIDED in this patient?

• A Topical beta-blockers such as timolol
• B Topical alpha-agonists such as brimonidine
• C Topical prostaglandin analogues such as latanoprost
• D Systemic carbonic anhydrase inhibitors such as acetazolamide ✓

Explanation

Carbonic anhydrase inhibitors lower the pH of the aqueous humour, which promotes sickling of red blood cells trapped in the anterior chamber. Sickled cells are rigid and obstruct the trabecular meshwork further, worsening the pressure rise, so they are avoided in hyphema patients with sickle cell haemoglobinopathies. Beta-blockers, alpha-agonists, and prostaglandin analogues do not alter aqueous pH and are safe alternatives in this setting.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.