Which of the following is a known adverse effect of topical carbonic anhydrase inhibitors used in glaucoma?

Which of the following is a known adverse effect of topical carbonic anhydrase inhibitors used in glaucoma?

• A. Bitter taste
• B. Metabolic acidosis
• C. Myopic shifts
• D. Bone marrow suppression

Answer: (A)

Topical carbonic anhydrase inhibitors for glaucoma, such as dorzolamide and brinzolamide, are best known for causing a bitter taste after administration. The drop can drain through the nasolacrimal duct into the oropharynx, where it interacts with taste receptors and produces dysgeusia. This is a characteristic, patient-reported side effect and reflects the drug’s local exposure rather than a systemic issue. Metabolic acidosis would be more typical of systemic carbonic anhydrase inhibitors like acetazolamide, since topical drops are only minimally absorbed. Bone marrow suppression and myopic shifts are not recognized adverse effects of these topical agents; the common ocular irritation and conjunctival hyperemia may occur, but the distinctive bitter taste remains the classic adverse effect.

Topical carbonic anhydrase inhibitors for glaucoma, such as dorzolamide and brinzolamide, are best known for causing a bitter taste after administration. The drop can drain through the nasolacrimal duct into the oropharynx, where it interacts with taste receptors and produces dysgeusia. This is a characteristic, patient-reported side effect and reflects the drug’s local exposure rather than a systemic issue. Metabolic acidosis would be more typical of systemic carbonic anhydrase inhibitors like acetazolamide, since topical drops are only minimally absorbed. Bone marrow suppression and myopic shifts are not recognized adverse effects of these topical agents; the common ocular irritation and conjunctival hyperemia may occur, but the distinctive bitter taste remains the classic adverse effect.