Sabite Emine GOKCE, Sedef KUTLUK, Alper YARANGUMELİ, Gulcan KURAL

Bilateral acute myopia and angle-closure glaucoma in a migraine patient receiving Topiramate: a case report

We present a case of topiramate-induced angle-closure glaucoma that was treated with cycloplegia. A 40-year-old woman with a history of migraine presented with bilateral acute onset of blurred vision and headache. She had been prescribed 50 mg of oral topiramate bid for migraine prophylaxis 10 days prior to her presentation. On her ocular examination visual acuity was 20/20 with a myopic correction of -4.0 diopters in both eyes. Bio-microscopic examination revealed bilateral shallow peripheral anterior chambers. Intraocular pressures were 37 OD and 36 OS. On gonioscopic examination bilateral 360 degrees of angle closure was seen. B-scan ultrasonography showed peripheral choroidal effusions. The mainstay of the treatment for topiramate induced secondary angle closure is cyloplegia. Whenever a case of bilateral acute angle-closure glaucoma associated with myopia and shallow anterior chambers is encountered, ciliochoroidal effusion syndrome induced by drugs should be considered in the differential diagnosis.

Keywords:

Acute myopia, glaucoma; migraine; topiramate,

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Banta JT, Hoffman K, Budenz DL, Ceballos E, Greenfield DS. Presumed topiramateinduced bilateral acute angle-closure glaucoma. Am J Ophthalmol 2001;132:112-4.
Fraunfelder FW, Fraunfelder FT, Keates EU. Topiramate associated acute, bilateral, secondary angle closure glaucoma. Ophthalmology 2004;111:109-11.
Spaccapelo L, Leschiutta S, Aurea C, Ferrari A. Topiramate-associated acute glaucoma in a migraine patient receiving concomitant citalopram therapy: A case-report. Cases J 2009;2:87.
Rhee DJ, Ramos-Esteban JC, Nipper KS. Rapid resolution of topiramate induced angle-closure glaucoma with methylprednisolone and mannitol. Am J Ophthalmol 2006;141:1133-4.
Rutstein RP, Daum KM, Amos JF. Accommodative spasm: A study of 17 cases. J Am Optom Assoc 1988;59:527-38.
London R, Wick B. Kirschen D. Post-traumatic pseudomyopia. Optometry 2003;74:111-20.
Moore S, Stockbridge L. Another approach to treatment of accommodative spasm. Am Orthopt J 1973;23:71-2.
Lee GC, Tam CP, Danesh-Meyer HV, Myers JS, Katz LJ. Bilateral angle closure glaucoma induced by sulphonamide-derived medications. Clin Experiment Ophthalmol 2007;35:55-8.