**4. Benzodiazepines (BZD)**

Benzodiazepines are among the most commonly prescribed drug class in psychiatry and exhibit sedative, hypnotic, anxiolytic and muscle-relaxing properties by enhancing the effect of gamma aminobutyric acid (GABA). Due to this effect, benzodiazepines are incriminated to influence the sphincter pupillae and to determine the narrowing of iridocorneal angle [75]. Current literature documents only the relationship of BZD with ACG and AACG.

Until recently, few cases have been reported about the association of AACG with BZD treatment. The conclusions were rather ambiguous, given the fact that other psychotropic agents have been concomitantly used during the time AACG was reported to occur [75]. Park et al. (2019) tried to reveal the clear relationship between benzodiazepine usage and the risk of glaucoma. In this population-based case-control study on elderly patients, who are more susceptible to the adverse effects to BZD, the authors demonstrated a significant correlation between immediate new use of BZD (within 7 days of AACG diagnosis) and the occurrence of AACG. Oppositely, no significant change in AACG incidence in the nonimmediate new users was reported. In addition, there was no significant difference between short half-life (<24 h) vs. long half-life (>24 h) benzodiazepine agents [76]. These findings are similar to the ones of Kim et al. (2020), who outlined an association between BZD therapy and AACG in a cohort of 6709 patients [75]. In the study group the most frequent prescribed BZD were Diazepam and Alprazolam. These drugs were also associated with the highest risk of AACG occurrence [75]. However, a different study concluded that diazepam reduced the IOP and would actually be safe in procedures where lowered IOP is desirable [77].

Therefore, we conclude that benzodiazepines could precipitate ACG in predisposed eyes and clinicians should be aware of these possible side effects.
