To the Editor. —
In their recent article,1 Berdy et al have suggested that angle closure glaucoma was precipitated by aerosolized atropine either by inadvertent topical application or systemic absorption. This conclusion is unwarranted and is based on a misunderstanding of the pathophysiologic features underlying angle closure glaucoma. As the authors correctly state, the mechanism responsible for angle closure glaucoma is pupil block. This is a posteriorly directed vector that is produced by the resolution of forces caused by cocontraction of the iris sphincter and dilator muscles.2 This force tightly opposes the pupil margin to the lens and is not simply an increased area of lens-iris contact, as the authors suggest. Neither pupil dilation nor constriction reliably produces angle closure in susceptible patients.2The idea that angle closure glaucoma could be induced by parasympatholytics has been disproved by Mapstone.2 He performed pilocarpine and phenylephrine provocative tests
Clearkin LG. Angle Closure Glaucoma Precipitated by Atropine. Arch Intern Med. 1992;152(4):880. doi:10.1001/archinte.1992.00400160160036
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