Which of the following lists the contraindications of CAIs?

• A. Glaucoma, age under 18
• B. Sulfa allergies, sickle cell w/ hyphema, low endothelial cell count
• C. Renal failure only
• D. Pregnancy only

Answer: (B)

CAIs lower aqueous humor production by inhibiting carbonic anhydrase in the ciliary body, and they are sulfonamide derivatives. Because of that sulfa allergy is a clear contraindication, since a hypersensitivity reaction can occur with these drugs. In sickle cell disease with hyphema, systemic CAIs can cause metabolic disturbances such as acidosis and dehydration that may worsen sickling and complicate the hyphema, so this situation is also contraindicated. Eyes with a very low endothelial cell count are prone to corneal edema, and CAIs can exacerbate that risk, making them unsuitable in that context. The other options don’t consistently capture these specific risks, so this combination is the correct set of contraindications.