Which drug class should be used with caution in patients with narrow-angle glaucoma due to risk of angle closure?

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

Answer: (A)

In narrow-angle glaucoma, keeping the pupil from dilating is important because pupil dilation can push the iris forward and narrow or close the drainage angle, triggering a dangerous rise in intraocular pressure. Medications that cause pupil dilation or increase sympathetic activity are the ones to use with caution in these patients.

A decongestant like pseudoephedrine fits this risk profile because it can cause mydriasis (pupil dilation) and potentially precipitate angle closure in someone with a susceptible angle. So it’s the drug class to avoid or use with caution in this context.

The other listed drugs don’t carry the same acute risk for angle closure. Corticosteroids can raise intraocular pressure in steroid responders over time, but they are not typically triggers for acute angle closure. NSAIDs and acetaminophen do not affect the angle in this way.