Which decongestant requires caution in patients with narrow-angle glaucoma?

• A. Acetaminophen
• B. Pseudoephedrine
• C. Indomethacin
• D. Corticosteroids

Answer: (B)

Pupil dilation from adrenergic stimulation can precipitate angle closure in narrow-angle glaucoma. Pseudoephedrine is a systemic sympathomimetic decongestant that can cause mydriasis, which may push the iris into the drainage angle and abruptly raise intraocular pressure. Because of this risk, it requires caution or avoidance in patients with narrow-angle glaucoma.

The other options don’t carry this decongestant-associated risk in the same way. Acetaminophen is a pain/fever reducer with no effect on pupil size or ocular drainage. Indomethacin is an NSAID with no decongestant mechanism. Corticosteroids can elevate intraocular pressure with prolonged use, but they are not decongestants and don’t pose the same immediate angle-closure risk when treating nasal congestion.