Background Psychotropic drugs are widely used, yet their class-specific impact on glaucoma and intra-ocular pressure (IOP) remains unclear.
Methods A Bayesian random-effects meta-analysis pooled 22 observational studies including 293,228 psychotropic users. Glaucoma risk was summarized with pooled odds ratios (OR), and IOP change with Hedges g.
Results Selective serotonin re-uptake inhibitors (SSRIs) reduced the odds of open-angle glaucoma by 17 % (OR 0.832, 95 % CrI 0.753–0.921) and produced a modest, consistent IOP decrease (g = –0.332, 95 % CrI –0.487 to –0.179). Benzodiazepines (including Z-drugs) increased overall glaucoma risk by ≈55 % (OR 1.550, 95 % CrI 1.436–1.674), with low heterogeneity across studies. Topiramate exhibited the strongest association, tripling the probability of angle-closure glaucoma (OR 3.930, 95 % CrI 1.784–11.465). Tricyclics, SNRIs, bupropion and methylphenidate showed no significant effects, although evidence was limited and heterogeneous.
Conclusions SSRIs may confer an ocular-protective effect, whereas benzodiazepines—and especially topiramate—represent clinically meaningful triggers for angle closure. Routine anterior-segment evaluation and early ophthalmologic follow-up are advisable for patients commencing these higher-risk agents, particularly those with narrow angles. Prospective, molecule-specific studies incorporating dose and treatment duration are essential to refine these risk estimates and guide safer psychopharmacology.