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 other non-depolarizing 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 ophtalmic 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
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