**7. Conclusions**

Based on the presented data, clinicians should be aware of the glaucoma-related riskbenefit profile of psychotropic medication and tailor their recommendations. The selective serotonin and noradrenaline reuptake inhibitors class is the medication group with the most solid results regarding a minimal possible risk of glaucoma. More precisely, SSRI and SNRI treatment seems to have even a protective role regarding OAG and no effect in relationship with ACG. Therefore, practitioners could use these drugs safely since there is no risk of a glaucoma induced effect. On the other hand, tricyclic antidepressants should be avoided in patients at risk to develop angle closure glaucoma or in angle closure glaucoma diagnosed individuals due to their strong anticholinergic and antimuscarinic proprieties. Regarding

all antipsychotics, there is an important gap in the knowledge of their relationship with the risk of glaucoma. Based on the herein reviewed data, first generation antipsychotics do not seem to affect the intraocular pressure, but for the second generation antipsychotics, and especially ziprasidone, further studies are needed in order to bring some light to the current data. Also, topiramate is another drug that we advise not be used in the treatment of patients with possible risk factors or diagnosed with angle closure glaucoma, since current data point to an increased risk of trabecular obstruction and consequently a raise in intraocular pressure. Benzodiazepines should be prescribed carefully, especially in older patients. Whether or not it is identified as a contraindication, physicians should be aware of the possibility of psychotropic drug-induced glaucoma, especially angle closure type, and if the suspicion of glaucoma arises, ophthalmological assessment is recommended. Early recognition of this possible side effect and discontinuation of the drug in question are measures that should be immediately employed by the psychiatrist concomitantly with referring the patient to an ophthalmologist for a thorough evaluation. Due to the vast psychotropic medication and possible mechanisms and their interactions, future studies are needed to fill the literature gaps and enrich current knowledge on this subject.

**Author Contributions:** Conceptualization, A.M.C. and C.N.; methodology, A.M.C., V.D. and O.P.-V.; software, C.N.; validation, A.M.C., O.P.-V. and S.R.; formal analysis, C.N.; investigation, A.M.C., V.D., C.N.; resources, V.D., C.N., O.M.B.; data curation, V.D., O.M.B.; writing—original draft preparation, A.M.C., V.D., C.N.; writing—review and editing, A.M.C., O.P.-V., S.R., O.M.B.; visualization, O.P.-V.; supervision, S.R.; project administration, A.M.C.; funding acquisition, V.D., C.N. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** All data relevant to this paper are included in the article.

**Acknowledgments:** We would like to thank Ioana Robu for the professional language assistance.

**Conflicts of Interest:** The authors declare no conflict of interest.
