Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA.
Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA.
Am J Emerg Med. 2022 Apr;54:329.e1-329.e3. doi: 10.1016/j.ajem.2021.10.057. Epub 2021 Nov 3.
Acute angle closure glaucoma is a sight-threatening condition that may lead to blindness. This is a case report of a woman who presented to the emergency department (ED) with acute angle closure glaucoma following use of an over-the-counter (OTC) homeopathic eye drop containing atropa belladonna (deadly nightshade). A 55-year-old woman presented to the ED with a 5-day history of left eye redness, swelling, tearing, and foreign-body sensation that had acutely worsened in the last two days. Her exam revealed mild left conjunctival injection with watery tearing and a hazy appearance of her left cornea. Fluorescein staining was negative, while tonometry revealed elevated intraocular pressure on the left, suggestive of acute angle closure glaucoma. She was urgently referred to ophthalmology. The etiology of the acute angle closure glaucoma was initially unclear however, with additional prompting, she revealed that two days prior she had started using homeopathic OTC eye drops. Inspection of the eyedrop's ingredients revealed that atropa belladonna was the primary ingredient and likely precipitated her isolated episode of acute angle closure glaucoma. A high level of clinical suspicion and focused ophthalmic exam including tonometry is essential to identify acute angle closure glaucoma in the ED. We present a case report of acute angle closure glaucoma associated with the use of homeopathic belladonna-containing eyedrops. Our report reinforces the necessity to perform thorough medication and supplement history given the prevalence of physiologically active substances available in OTC medications.
急性闭角型青光眼是一种可致盲的致盲性眼病。这是一例因使用含有颠茄（致命毒蕈）的非处方顺势疗法眼药水而导致急性闭角型青光眼的女性病例报告。一名 55 岁女性因左眼红肿、肿胀、流泪和异物感就诊于急诊（ED），病史为 5 天，前两天症状急剧恶化。她的检查显示左眼轻度结膜充血，伴有水样流泪和左眼角膜混浊。荧光素染色阴性，眼压测量显示左眼眼压升高，提示急性闭角型青光眼。她被紧急转至眼科。急性闭角型青光眼的病因最初不清楚，但在进一步询问下，她透露两天前开始使用非处方顺势疗法眼药水。检查眼药水的成分显示，颠茄是主要成分，可能引发了她孤立的急性闭角型青光眼发作。在急诊室中，高度的临床怀疑和重点眼科检查，包括眼压测量，对于识别急性闭角型青光眼至关重要。我们报告了一例与使用含有颠茄的顺势疗法眼药水相关的急性闭角型青光眼病例。我们的报告强调了由于在非处方药物中存在大量具有生理活性的物质，因此进行彻底的药物和补充剂历史记录非常必要。
