Management of Pain in Open-Angle Glaucoma

Schmerzmanagement bei Offenwinkelglaukom

The American Geriatrics Society recommends paracetamol as the first choice for mild to moderate pain due to its favorable side effect profile compared to NSAIDs 1, 2
Non-selective NSAIDs like ibuprofen or naproxen can be used as a second option when paracetamol is not sufficient, with the goal of using the lowest effective dose for the shortest possible time to minimize the risk of side effects 3

The American Heart Association notes that NSAIDs may be associated with an increased cardiovascular risk, particularly in patients with pre-existing cardiovascular diseases 3
The American Geriatrics Society warns of an increased risk for gastrointestinal side effects, especially in older patients, and potential interactions with other medications 1

The American Geriatrics Society suggests that topical analgesics or counterirritants (e.g., methylsalicylate, capsaicin cream, menthol) can be helpful for local pain relief 4
The European League Against Rheumatism recommends physical activity and exercises as a contributing factor to pain relief, especially for arthritic pain 2, 5

The American Academy of Ophthalmology advises that procedures which can temporarily increase intraocular pressure should be avoided in patients with advanced glaucomatous damage 6

Topical carbonic anhydrase inhibitors such as Dorzolamid and Brinzolamid are used to treat glaucoma and have a positive effect on intraocular pressure, according to the American Academy of Ophthalmology 7, 8
The American Academy of Ophthalmology recommends regular monitoring of intraocular pressure in patients with glaucoma who are taking pain medications, with a goal of reducing intraocular pressure by approximately 20% from baseline 7, 9
Target intraocular pressure values should be individually determined, typically about 20% lower than the baseline value, as suggested by the American Academy of Ophthalmology 9, 10
If there is a worsening of the visual field or optic nerve findings, the pain therapy should be adjusted, according to the American Academy of Ophthalmology 9

Acetazolamide, an oral carbonic anhydrase inhibitor, is used to treat glaucoma but has significant side effects such as Stevens-Johnson syndrome, electrolyte disturbances, and kidney stones, and its use requires careful consideration of the risks and benefits 11