Glaucoma is a common condition that damages the optic nerve, usually as a result of an increase in intraocular pressure (IOP). It can be divided into two types: open-angle glaucoma (OAG) and acute angle-closure glaucoma (AACG). OAG is believed to occur due to dysfunction in aqueous outflow through the trabecular meshwork (TM) of the eye as it flows from the posterior to the anterior chamber. AACG manifests when a bulging iris blocks the iridocorneal angle, commonly caused by pupillary block due to pupil dilation, leading to fluid buildup and increased IOP, potentially resulting in complete vision loss. As a result of an aging population, chronic conditions are increasing in number, necessitating the use of systemic medications to treat them. However, many of these medications may affect the eye, predisposing it to different ocular morbidities. This narrative review will examine the effects of these medications on glaucoma development, specifically focusing on the effects of corticosteroids on OAG through increased aqueous humor resistance in the TM and the effects of sulfonamides, anticholinergics, antidepressants, cholinergics, anticoagulants, and certain supplements on AACG as a result of their sympathomimetic properties and the disruption of the lens-iris structure.

A woman in her 30s presented with sudden bilateral vision loss, ocular pain, headache, nausea and vomiting. She had been taking topiramate for migraine prophylaxis for 10 days. Examination revealed shallow anterior chambers and intraocular pressure (IOP) of 59 mm Hg OD and 55 mm Hg OS, with appositional angle closure. Anterior segment optical coherence tomography confirmed closed angles and ultrasound biomicroscopy revealed ciliary body effusion. A diagnosis of topiramate-induced acute angle closure was made. Prompt treatment with systemic and topical steroids, cycloplegics, mannitol and topical anti-glaucoma drugs led to rapid improvement in vision and IOP within 6 hours. Full recovery was achieved by day 3. Acetazolamide triggered a recurrence of elevated IOP. This case highlights the importance of early initiation of systemic steroids, which can result in rapid anatomical and functional recovery, and underscores the potential for acetazolamide to worsen angle closure in such cases.

Choroidal metastasis is the most common intraocular malignancy in adults and may present as the initial manifestation of an underlying systemic malignancy. We report a case of a 62-year-old woman who presented with unilateral progressive visual deterioration and was initially referred with a working diagnosis of ocular tuberculosis (TB). Ocular examination revealed a non-pigmented choroidal mass with exudative retinal detachment. Subsequent imaging identified a lung lesion, and a primary lung malignancy was suspected based on contrast-enhanced computed tomography of the thorax. Histopathological examination later confirmed lung adenocarcinoma. The choroidal metastasis demonstrated rapid progression, with anterior extension leading to shallowing of the anterior chamber, rubeosis iridis, and eventual development of neovascular glaucoma (NVG) with acute angle closure. The patient developed severe ocular pain with markedly elevated intraocular pressure, which was refractory to maximal medical therapy. Management was guided by the advanced stage of systemic disease and poor visual prognosis. As enucleation was declined by the patient, palliative external beam radiotherapy was performed, resulting in significant symptomatic relief. This case underscores the importance of early consideration of malignancy in atypical choroidal lesions, particularly in TB-endemic settings, and highlights the potential for rapid intraocular progression with significant complications. A multidisciplinary, patient-centred approach with emphasis on symptom palliation is essential in advanced disease.

BACKGROUND Glaucoma drainage implants, including the Paul glaucoma implant, are widely used in the management of refractory glaucoma when medical therapy and conventional filtering surgery prove insufficient. Although associated with favorable outcomes, rare but serious postoperative complications such as endophthalmitis and panophthalmitis can occur, resulting in significant visual morbidity. CASE REPORT We describe the case of a 77-year-old man with chronic angle-closure glaucoma who developed acute panophthalmitis with orbital cellulitis 12 days following uneventful Paul glaucoma implant surgery. He presented with severe ocular pain, eyelid swelling, restricted ocular motility, and marked reduction in visual acuity to light perception. Clinical examination revealed pronounced anterior and posterior segment inflammation. B-scan ultrasonography showed dense vitreous opacities, shallow choroidal detachment, and ocular wall thickening. Computed tomography of the orbit confirmed associated orbital cellulitis with proptosis and extraocular muscle swelling. The patient underwent vitreous tap with intravitreal vancomycin, ceftazidime, and dexamethasone, along with intensive topical and systemic antimicrobial therapy. Despite an initial partial response, progressive inflammation required pars plana vitrectomy. Removal of the glaucoma drainage implant was not possible intraoperatively due to severe inflammation. Microbiological cultures remained negative throughout. With coordinated multidisciplinary management involving glaucoma, retina, and oculoplastic services, orbital inflammation gradually resolved, and visual acuity improved from light perception to 20/250 at final follow-up. CONCLUSIONS This case highlights the importance of close postoperative monitoring to ensure correct diagnosis and aggressive management of infections, preservation of globe integrity, and optimization of visual outcomes following glaucoma drainage device surgery.