Hydrochlorothiazide-Induced Hyponatremia: A Bilateral Acute Angle Closure Glaucoma Case Report

Abstract

Our objective is to report a case of bilateral acute glaucoma associated with hydrochlorothi-azide-induced hyponatremia.   An 83-year-old female patient, with arterial hypertension history, presented with severe ocular pain and decreased vision in both eyes, associated with headache, nausea and vomiting. On examination, visual acuity was counting fingers in both eyes. Biomicroscopy showed ciliary hyperemia, marked corneal edema and shallow anterior chamber. Intraocular pressure (IOP) was 59/68 mmHg. Gonioscopy revealed bilateral angle closure and UBM ciliary body effusion. Antihypertensive eye drops and intravenous mannitol were started. Blood tests revealed profound hyponatremia and hypochloremia. After electrolyte stability, laser iridoplasty was performed in both eyes, and previous hydrochlorothiazide prescription was suspended. Thereafter, progressive clinic improvement was verified, with IOP normalization. Bilateral acute angle closure has been associated with sulfonamide derivative medications. The development of bilateral ciliary effusions and angle closure potentially due to hydrochloro-thiazide-induced-hyponatremia, had been reported only once in literature.