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to report a case of bilateral acute angle - closure glaucoma after oral administration of cabergoline for the treatment of galactorrhea .
a diagnosis of secondary drug - induced angle - closure glaucoma was made in a patient with elevated intraocular pressure ( iop ) and myopic refractive shift , which was confirmed by ultrasound biomicroscopy ( ubm ) of the ciliary body and anterior segment , sonography , and optical coherence tomography .
the treatment included the discontinuation of the culprit drug and the administration of topical anti - glaucoma drops .
the treatment course was followed with serial measurements of the iop and refraction , and with performing ubm .
five hours after he received a single 0.5-mg oral cabergoline tablet , the patient suffered from acute secondary angle - closure glaucoma and myopic refractive error .
ubm demonstrated both effusion of the ciliary body and an anterior rotation of the iris - ciliary body .
iop was reduced 8 h after cessation of the causative agent and administration of anti - glaucoma drops .
secondary acute angle - closure glaucoma has been reported to occur after the administration of some drugs . in this report , an attempt has been made to describe this adverse reaction after oral cabergoline intake .
several types of drugs , such as adrenergic agonists , cholinergics , anti - cholinergics , sulfa - based drugs ( e.g. topiramate ) , selective serotonin reuptake inhibitors , tricyclic and tetracyclic anti - depressants , anticoagulants , and antihistamines , have been reported to induce secondary acute angle - closure glaucoma [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] .
cabergoline ( brand names dostinex and cabaser ) , an ergot derivative , is a potent dopamine d2 receptor agonist .
the drug is prescribed in parkinson 's disease , prolactin - producing pituitary gland tumors , ablactation and dysfunctions associated with hyperprolactinemia .
it stimulates dopamine receptors in lactophilic hypothalamic cells to suppress prolactin secretion in the pituitary gland [ 13 , 14 ] . to the best of our knowledge ,
she was prescribed 0.5-mg oral cabergoline tablets by her gynecologist ( one tablet per week ) ; however , she did not receive any other medication .
five hours after ingestion of the first single dose of cabergoline , the patient was referred to our hospital suffering from bilateral painful red eyes , blurred vision , headache , nausea , and vomiting . initially , the symptoms occured in her left eye , but , consequently , they also developed in her right eye .
the patient had no past medical and familial history of glaucoma , other ophthalmologic diseases or refractive errors .
ocular examination revealed an uncorrected visual acuity of 20/200 in the right and 20/400 in the left eye , normal external ocular motion in both eyes , 5-mm pupils in both eyes that were nonreactive to light , a conjunctival hyperemia and a perilimbal injection .
in addition , the examination showed a microcystic corneal edema , a shallow anterior chamber , a closed angle in gonioscopy as well as a clear lens .
the fundus demonstrated normal disc and vessels , a normal foveal light reflex as well as some perifoveal retinal wrinkling secondary to choroidal thickening .
the intraocular pressure ( iop ) , measured using goldmann applanation tonometry , was 40 mm hg in the right and 42 mm hg in the left eye .
refractive errors were 7.75 dpt sph and 1.00  94 cyl in the right eye , and 9.00 dpt sph and 0.50  56 cyl in the left eye .
ultrasound biomicroscopy with a 40-mhz probe showed ciliochoroidal thickening , effusion underneath the ciliary body , narrowing of the angle and anterior rotation of the iris - ciliary body in both eyes ( fig .
measured axial lengths were 23.22 and 23.24 mm in the right and left eye , respectively .
the anterior chamber depth was 1.33 mm in the right and 1.34 in left eye .
treatment of the patient was immediately started with the discontinuation of cabergoline as the suspicious causal drug .
the elevated iop was treated with topical timolol maleate 0.5% every 12 h , brimonidine tartrate 0.1% every 8 h , and latanoprost 0.005% every 24 h. glaucoma was controlled 8 h after medical treatment , iop was reduced to 25 mm hg in both eyes , conjunctival hyperemia was reduced , and ocular pain was alleviated ; however , the patient still had a myopic shift in refraction .
finally , by 8 days after cessation of cabergoline , the refraction returned to normal levels .
cabergoline is absorbed from the gastrointestinal tract within 0.5 to 4 h , with an average elimination half - life of 80 h. seventy - nine percent of the patients taking this drug report at least one side effect .
these side effects are chiefly mild or moderate , including nausea , constipation , dry mouth , gastric irritation , dyspepsia , sleep disturbances , vertigo , depression , dyskinesia , hallucinations , systemic hypotension , peripheral edema , arrhythmia , and angina pectoris [ 15 , 16 , 17 , 18 , 19 , 20 ] .
we were not able to find any previous report of glaucoma symptoms and signs in the literature .
acute drug - induced bilateral glaucoma is a relatively uncommon but serious adverse reaction which , if not recognized in a timely manner , may result in severe morbidity and even permanent visual damage .
its treatment differs from that of primary acute angle - closure glaucoma , i.e. it is necessary to discontinue the drug for controlling glaucoma [ 1 , 2 , 3 , 4 , 5 ] .
purposeto report a case of bilateral acute angle - closure glaucoma after oral administration of cabergoline for the treatment of galactorrhea.methodsa diagnosis of secondary drug - induced angle - closure glaucoma was made in a patient with elevated intraocular pressure ( iop ) and myopic refractive shift , which was confirmed by ultrasound biomicroscopy ( ubm ) of the ciliary body and anterior segment , sonography , and optical coherence tomography . 
 the treatment included the discontinuation of the culprit drug and the administration of topical anti - glaucoma drops . 
 the treatment course was followed with serial measurements of the iop and refraction , and with performing ubm.resultsfive hours after he received a single 0.5-mg oral cabergoline tablet , the patient suffered from acute secondary angle - closure glaucoma and myopic refractive error . 
 ubm demonstrated both effusion of the ciliary body and an anterior rotation of the iris - ciliary body . 
 iop was reduced 8 h after cessation of the causative agent and administration of anti - glaucoma drops . 
 refractive errors returned to normal levels after 8 days.conclusionsecondary acute angle - closure glaucoma has been reported to occur after the administration of some drugs . in this report 
 , an attempt has been made to describe this adverse reaction after oral cabergoline intake .