Topiramate-induced Acute Angle-Closure Glaucoma

ABSTRACT

PURPOSE: We describe 2 cases of bilateral acute angle-closure glaucoma associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. METHODS: A 51-year-old man and a 27-year-old woman, previously devoid of ocular problems, visited the emergency room with blurry vision after taking topiramate for epilepsy and weight reduction, respectively. Thorough medical history taking and ocular examinations including ultrasound biomicroscopy were performed. RESULTS: Ultrasound biomicroscopy revealed supraciliary choroidal effusion causing forward displacement of the lens-iris diaphragm, which resulted in myopia, anterior chamber shallowing, and increased intraocular pressure by angle-closure. Discontinuation of topiramate and the administration of cycloplegics, steroids and pressure-lowering agents led to the resolution of the symptoms. CONCLUSIONS: An idiosyncratic reaction of topiramate may produce supraciliary choroidal effusion and ciliary body edema, resulting in anterior displacement of lens-iris diaphragm, increased myopia and acute angle-closure glaucoma. Thorough medical history taking and ocular examinations are necessary to rule out the drug-induced acute angle-closure glaucoma.