Effect of Ephedrine on Intraocular Pressure
Mechanism of Action and Risk
- Ephedrine acts as an α-adrenergic agonist with sympathomimetic properties that can cause mydriasis (pupillary dilation), which reduces aqueous humor outflow through the trabecular meshwork in susceptible eyes 2
- The American College of Cardiology recommends that ephedrine is contraindicated in patients at risk of increased intraocular pressure, particularly those with glaucoma or narrow angles, as it can precipitate acute angle-closure glaucoma through its sympathomimetic effects causing pupillary dilation 1
Clinical Evidence and Contraindications
- The American College of Cardiology/American Heart Association explicitly lists ephedrine as a drug that can precipitate acute angle-closure glaucoma attacks in patients with narrow angles or glaucoma 1
- High-risk patients include those with narrow angles on gonioscopy, family history of glaucoma, or pre-existing elevated intraocular pressure 2