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To the Editor:—
The use of acetazolamide (Diamox) as a diuretic carries with it implications and dangers of which many physicians are insufficiently aware. The drug is contraindicated in individuals with chronic narrow-angle glaucoma since its potent action in diminishing aqueous production serves to maintain normal intraocular tension even as peripheral anterior synechiae are building up. A similar mechanism may apply in persons with very shallow anterior chambers whose outflow mechanism is on the verge of embarrassment or even where minor elevations of tension occur with barely recognizable symptoms. In these individuals, the use of the drug may mask the occlusive process in the angle of the anterior chamber by producing and maintaining a normal intraocular tension. Accordingly, it is my feeling that acetazolamide should never be used except with the endorsement of the ophthalmologist, or where the physician is assured of the depth of the anterior chamber. These considerations
Goodside V. Acetazolamide and Glaucoma. JAMA. 1961;176(5):466. doi:10.1001/jama.1961.03040180068024