Ethyl alcohol is widely used as a licit and socially acceptable albeit nonprescrip-tion drug. Alcohol has many ocular effects, including influences on eye movements, nystagmus, and amblyopia. At relatively high doses, alcohol also affects IOP. The mechanism of lowering IOP is an osmotic effect, which may be limited in degree and duration due to rapid penetration into the eye. However, alcohol also induces a hypotonic diuresis by inhibiting production of antidiuretic hormone, which may prolong and increase the osmotic gradient.

Lower doses of alcohol have little or no effect on IOP. Oral administration of 21 mL of 86- or 90-proof alcohol (43% or 45% alcohol, respectively) had no significant effect on IOP compared with controls.64 Higher doses, however, may reduce IOP (see chapter 8). The oral dose of ethyl alcohol for lowering IOP is 0.8 to

1.5 g/kg, which is approximately 2 to 3mL/kg of body weight of 40% to 50% solution (80 to 100 proof). Oral ingestion of 120 cc (4 oz, approximately equivalent to two cocktails) of whiskey or 1 L of beer (5% alcohol content) was equally effective in reducing IOP for at least 4 to 5 hours.65

Ethyl alcohol has many well-known short- and long-term side effects that limit the therapeutic use of this drug. At the higher doses required to lower IOP, alcohol has central nervous system side effects and may cause nausea and vomiting. The hypotonic diuresis may cause dehydration, and the metabolism of alcohol causes increased caloric load after ingestion, which may cause side effects in diabetic patients and even in nondiabetic individuals.

Because of its adverse effects, long-term treatment with alcohol is not recommended for treatment of elevated IOP. Short-term therapy with alcohol is rarely, if ever, necessary, such as in an emergency situation when no other osmotic IOP-lowering drug is available. However, IOP measurements may be temporarily lowered by alcohol and may deceive clinicians trying to monitor and interpret these measurements. Patients may not state that they have ingested alcohol, although the alert clinician is usually aware of this possibility.

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