Topiramate-associated acute, bilateral, angle-closure glaucoma: Case report

Abstract

This paper describes a topiramate induced acute bilateral angle-closure glaucoma. This rare adverse effect is an idiosyncratic reaction characterized by uveal effusionand lens forward displacement, leading to increased intraocular pressure andvision loss. We describe a 55 year-old white woman with migraine, spasmodictorticollis and essential tremor, who developed bilateral acute angle-closureglaucoma, one week after starting topiramate 25 mg/day. She was seen at the Ophthalmology Emergency Department of the Fundação João Penido Burnier(Campinas, SP, Brazil) with a 4 hours history of blurry vision, ocular pain and brightflashes vision. Slit lamp examination revealed moderate conjunctival injectionand corneal edema, and shallow anterior chambers. Intraocular pressure was48 mmHg in both eyes. Fundoscopic examination findings were normal. Shewas treated with timolol, brimonidine, dorzolamide, pilocarpine, prednisoneacetate eye drops and acetazolamide. One hour after those measures, as theintraocular pressure was 30 mmHg, she received a manitol intravenous injectionand the intraocular pressure normalized. After 24 hours an iridotomy with Yaglaser was performed. Topiramate was discontinued and she was totally recoveredafter one week.