Which drugs are associated with an increase in intraocular pressure?

• A. Anticholinergic activity drugs + TCAs
• B. Systemic beta-blockers
• C. Acetaminophen
• D. NSAIDs

Answer: (A)

Medications that block acetylcholine activity or have strong anticholinergic effects can raise intraocular pressure by reducing aqueous humor outflow and promoting pupil dilation. Anticholinergic drugs prevent the ciliary muscle from facilitating drainage through the trabecular meshwork, and when pupil size increases (mydriasis), the iridocorneal angle can narrow, especially in eyes with narrow angles, leading to higher pressure. Tricyclic antidepressants carry notable anticholinergic effects, so they contribute to this same mechanism and can raise IOP in susceptible individuals.

Systemic beta-blockers tend to reduce aqueous humor production and thus lower IOP rather than raise it. Acetaminophen and NSAIDs do not typically increase IOP; their effects on the eye’s drainage pathway aren’t linked to pressure elevation.