Case study: Atropine may cause nausea, vomiting

Clinicians and patients with diabetes should be aware of the possible systemic side effects of treatments for elevated IOP and glaucoma, according to two physicians.

Roger Kenneth Eagan, MD, and Pninit Varol, MD, described the case of a 62-year-old white man with glaucoma and long-standing type 2 diabetes complicated by peripheral neuropathy and retinopathy. He had presented with persistent nausea and vomiting and diagnosed with presumed symptomatic glaucoma. Three months earlier, he had undergone pars plana vitrectomy and had developed subsequent neovascular glaucoma.

After left eye pain intensified, he was diagnosed with increasing IOP, and his atropine regimen was intensified. He was diagnosed with gastroparesis, and atropine therapy was discontinued. His symptoms improved to where he could take food by mouth, the physicians reported. Once atropine therapy was restarted, however, the patient’s nausea and vomiting returned.

To optimize the symptom management and maintain the necessary ophthalmic regimen, the patient was put on metoclopramide and erythromycin.

The study is published in Clinical Diabetes.