Intraocular pressure and anaesthetic drugs

Regarding intraocular pressure and drugs used in anaesthesia, the following statements are true EXCEPT which one?

a) Intravenous midazolam reduces intraocular pressure

b) Metoclopramide causes an increase in intraocular pressure

c) Atracurium has no effect on intraocular pressure

d) Rocuronium reduces intraocular pressure

e) All intravenous induction agents reduce intraocular pressure, except ketamine

Answer: A

Explanation

The three agents commonly encountered in anaesthesia that raise intraocular pressure

are ketamine, suxamethonium and metoclopramide. Oral benzodiazepines and

intravenous midazolam have no effect, whereas intravenous diazepam reduces

intraocular pressure. Atracurium has no effect on intraocular pressure while all

other non-depolarising muscle relaxants reduce it. Opioids, volatile anaesthetic

agents and induction agents (except ketamine) reduce intraocular pressure.

Knowledge of these factors is of particular relevance to providing anaesthesia for

ophthalmic surgery involving traumatic or surgical disruption of globe integrity

where a rise in intraocular pressure may cause extrusion of globe contents and significant

patient detriment.

Reference

Raw D, Mostafa S. Drugs and the eye. Contin Educ Anaesth Crit Care Pain 2001; 1(6):

161–5.